CareFirst Procedure Code/Modifier/Place of Service ...

1 CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc., which are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS , BLUE SHIELD and the Cross and Shield Symbols are registered Service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Revised 07/13/2021 CareFirst Procedure Code/Modifier/Place of Service Instructions for Telemedicine Claims During Covid-19 Public Health Emergency Please note that we temporarily added additional codes to our telemedicine policy to address the current coronavirus public health emergency. These codes are labeled Temporary and are effective for dates of Service on and after March 16, 2020. Coverage of these codes may be re-evaluated after the public health emergency has subsided. The codes labeled Existing were included in Telemedicine Medical Policy Please note that the highlighted Procedure codes are not eligible for reimbursement when performed via audio-only services.

2 Procedure code Modifier Place of Service Temporary / Existing Policy 90785 95 or GT 02 Existing 90791 95 or GT 02 Existing 90792 95 or GT 02 Existing 90832 95 or GT 02 Existing 90833 95 or GT 02 Existing 90834 95 or GT 02 Existing 90836 95 or GT 02 Existing 90837 95 or GT 02 Existing 90838 95 or GT 02 Existing 90845 95 or GT 02 Existing 90846 95 or GT 02 Existing 90847 95 or GT 02 Existing 90849 95 or GT 02 Existing 90853 95 or GT 02 Existing 90863 95 or GT 02 Existing 90951 95 or GT 02 Existing 90952 95 or GT 02 Existing 90954 95 or GT 02 Existing 90955 95 or GT 02 Existing 90957 95 or GT 02 Existing 90958 95 or GT 02 Existing 90960 95 or GT 02 Existing 90961 95 or GT 02 Existing 90964 95 or GT 02 Temporary 90965 GT 02 Temporary 90966 95 or GT 02 Temporary 90967 GT 02 Temporary 90968 95 or GT 02 Temporary 90969 GT 02 Temporary 90970 95 or GT 02 Temporary CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc.

3 And Group Hospitalization and Medical Services, Inc., which are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS , BLUE SHIELD and the Cross and Shield Symbols are registered Service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Revised 07/13/2021 Procedure code Modifier Place of Service Temporary / Existing Policy 92227 95 or GT 02 Existing 92228 95 or GT 02 Existing 92507 95 or GT 02 Existing 92508 Do not submit a modifier 02 Temporary 92521 Do not submit a modifier 02 Temporary 92522 Do not submit a modifier 02 Temporary 92523 Do not submit a modifier 02 Temporary 92524 Do not submit a modifier 02 Temporary 92526 95 or GT 02 Existing 92626 Do not submit a modifier 02 Temporary 92627 Do not submit a modifier 02 Temporary 92630 Do not submit a modifier 02 Temporary 92633 Do not submit a modifier 02 Temporary 93228 95 or GT 02 Existing 93229 95 or GT 02 Existing 93268 95 or GT 02 Existing 93270 95 or GT 02 Existing 93271 95 or GT 02 Existing 93272 95 or GT 02 Existing 96040 95 or GT 02 Existing 96105 Do not submit a modifier 02 Temporary 96110 95 or GT 02 Temporary 96116 95 or GT 02 Temporary 96121 95 or GT 02 Temporary 96125 Do not submit a modifier 02

4 Temporary 96130 95 or GT 02 Temporary 96131 95 or GT 02 Temporary 96132 95 or GT 02 Temporary 96136 95 or GT 02 Temporary 96137 95 or GT 02 Temporary 96160 GT 02 Temporary 96161 GT 02 Temporary 97110 Do not submit a modifier 02 Temporary 97112 Do not submit a modifier 02 Temporary 97129 Do not submit a modifier 02 Temporary 97130 Do not submit a modifier 02 Temporary 97151 GT 02 Temporary 97153 Do not submit a modifier 02 Temporary 97155 GT 02 Temporary CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc., which are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS , BLUE SHIELD and the Cross and Shield Symbols are registered Service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Revised 07/13/2021 Procedure code Modifier Place of Service Temporary / Existing Policy 97156 GT 02 Temporary 97157 GT 02 Temporary 97161 Do not submit a modifier 02 Temporary 97162 Do not submit a modifier 02 Temporary 97164 Do not submit a modifier 02 Temporary 97165 Do not submit a modifier 02 Temporary 97166 Do not submit a modifier 02 Temporary 97168 Do not submit a modifier 02 Temporary 97530 95 or GT 02 Existing 97533 Do not submit a modifier 02 Temporary 97535 Do not submit a modifier 02 Temporary 97802 95 or GT 02 Existing 97803 95 or GT 02 Existing 97804 95 or GT 02 Existing 98960 95 or GT 02 Existing 98961 95 or GT 02 Existing 98962 95 or GT 02 Existing 99201 (effective through 12/31/20 only)

5 95 or GT 02 Existing 99202 95 or GT 02 Existing 99203 95 or GT 02 Existing 99204 95 or GT 02 Existing 99205 95 or GT 02 Existing 99211 95 or GT 02 Existing 99212 95 or GT 02 Existing 99213 95 or GT 02 Existing 99214 95 or GT 02 Existing 99215 95 or GT 02 Existing 99221 95 or GT 02 Existing 99222 95 or GT 02 Existing 99223 95 or GT 02 Existing 99231 95 or GT 02 Existing 99232 95 or GT 02 Existing 99233 95 or GT 02 Existing 99241 95 or GT 02 Existing 99242 95 or GT 02 Existing 99243 95 or GT 02 Existing 99244 95 or GT 02 Existing 99245 95 or GT 02 Existing 99251 95 or GT 02 Existing CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc., which are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS , BLUE SHIELD and the Cross and Shield Symbols are registered Service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

6 Revised 07/13/2021 Procedure code Modifier Place of Service Temporary / Existing Policy 99252 95 or GT 02 Existing 99253 95 or GT 02 Existing 99254 95 or GT 02 Existing 99255 95 or GT 02 Existing 99307 95 or GT 02 Existing 99308 95 or GT 02 Existing 99309 95 or GT 02 Existing 99310 95 or GT 02 Existing 99341 95 or GT 02 Existing 99342 95 or GT 02 Existing 99343 95 or GT 02 Existing 99344 95 or GT 02 Existing 99345 95 or GT 02 Existing 99347 95 or GT 02 Existing 99348 95 or GT 02 Existing 99349 95 or GT 02 Existing 99350 95 or GT 02 Existing 99354 95 or GT 02 Existing 99355 95 or GT 02 Existing 99381 Do not submit a modifier 02 Temporary 99382 Do not submit a modifier 02 Temporary 99383 Do not submit a modifier 02 Temporary 99384 Do not submit a modifier 02 Temporary 99385 Do not submit a modifier 02 Temporary 99386 Do not submit a modifier 02 Temporary 99387 Do not submit a modifier 02 Temporary 99391 Do not submit a modifier 02 Temporary 99392 Do not submit a modifier 02 Temporary 99393 Do not submit a modifier 02 Temporary 99394 Do not submit a modifier 02 Temporary 99395 Do not submit a modifier 02 Temporary 99396 Do not submit a modifier 02 Temporary 99397 Do not submit a modifier 02 Temporary 99401 95 or GT 02 Existing 99402 95 or GT 02 Existing 99403 95 or GT 02 Existing 99404 95 or GT 02 Existing 99406 95 or GT 02 Existing 99407 95 or GT 02 Existing CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc.

7 And Group Hospitalization and Medical Services, Inc., which are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS , BLUE SHIELD and the Cross and Shield Symbols are registered Service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Revised 07/13/2021 Procedure code Modifier Place of Service Temporary / Existing Policy 99408 95 or GT 02 Existing 99409 95 or GT 02 Existing 99495 95 or GT 02 Existing 99496 95 or GT 02 Existing 99497 GT 02 Temporary 99498 GT 02 Temporary G2025 Do not submit a modifier Do not submit a place of Service Temporary S9443 95 or GT 02 Existing