Review the Latest COVID-19 and RSV Billing Guidance
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”) remains committed to advancing affordable and accessible healthcare with an emphasis on preventative care and vaccinations. As such, CareFirst covers preventive vaccines for all our members.
For most of our members, preventive care is provided at no cost including flu shots, respiratory syncytial virus (RSV) vaccinations, and coronavirus vaccines when they provided by an in-network pharmacy or doctor’s office.
Coronavirus Vaccines
In accordance with Federal and state guidelines, providers should use monovalent mRNA COVIDs going forward. Our systems have been configured to deny the former COVID bivalent vaccine codes for dates of service on or after September 11.
Note: The Novavax COVID-19 vaccine product remains active.
Please refer here for additional information on the latest guidance.
RSV Vaccines and Treatment
We are covering RSV vaccination and other treatment for our members. Please refer here or go carefirst.com/providerguides. Review the medical accordion for billing guidance related to RSV.
Guidance for Hospitals: The RSV vaccine for newborns may be administered in the inpatient setting.
Guidance for Pharmacies: Some CareFirst plans have vaccine coverage carved out. Be sure to check benefits under both medical AND pharmacy coverage before telling a member a vaccine is not covered.
If you have questions on vaccine benefits or billing for CareFirst members, please contact customer service at the number on the back of the member’s identification card.
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