CommercialCoverageMedium impact
CareFirst Changes Coverage Determination for Certain Codes
CareFirst BlueCross BlueShield·Wound Care, Plastic Surgery, Dermatology +1 more·Provider News
Effective date
Aug 1, 2023
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield is changing five specific skin substitute material codes from covered to Experimental/Investigational status, meaning claims with these codes will be automatically denied. This affects wound care and burn treatment billing for non-healing wounds.
Action Required
Before August 1, 2023: Billing team must update system to flag codes A2011, A2012, A2013, A4100, and Q4238 as non-covered for CareFirst plans. Update encounter forms to alert providers these skin substitutes will be denied. Providers must identify alternative covered treatments or inform patients these materials will not be covered by CareFirst.