The Coverage Summaries are policies based on existing current Medicare National Coverage Determinations, Local Coverage Determinations, CareFirst Medical Policies, and applicable CareFirst BlueCross BlueShield Medicare Advantage Plans EOCs and SOBs intended to provide benefit coverage information and guidelines specific to CareFirst BlueCross BlueShield Medicare Advantage Plans.
Benefit interpretations for CareFirst BlueCross BlueShield Medicare Advantage Plan members are made on a case-by-case basis using the guidelines in the Coverage Summaries. The Coverage Summaries are subject to change based upon changes in Medicare's coverage requirements, changes in scientific knowledge and technology and evolving practice patterns.
Providers are responsible for reviewing the CMS Medicare Coverage Center guidance and in the event that there is a conflict between the Coverage Summaries and the CMS Medicare Coverage Center guidance, the CMS Medicare Coverage Center guidance will govern.
CMS Coverage Resources
CMS Local Coverage Determinations
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MCG Guidelines
For members
MCGTM Guidelines for CareFirst BlueCross BlueShield Medicare Advantage (PPO) Members
MCG Guidelines are proprietary and therefore, must be accessed using a secure log-in process. Please log into the CareFirst member portal and click on the Document Tab, Other Documents to view the Clinical Guidelines.
MCGTM Guidelines for CareFirst BlueCross BlueShield Advantage DualPrime Members
MCG Guidelines are proprietary and therefore, must be accessed using a secure log-in process. Please log into the CareFirst member portal and click on the Document Tab, Other Documents to view the Clinical Guidelines.
For Providers
MCGTM Guidelines for CareFirst BlueCross BlueShield Medicare Advantage (PPO) Providers
MCG Guidelines are proprietary and therefore, must be accessed using a secure log-in process. Please log into the CareFirst Provider Portal and click on the Resources Tab.
MCGTM Guidelines for CareFirst BlueCross BlueShield Advantage DualPrime Providers
MCG Guidelines are proprietary and therefore, must be accessed using a secure log-in process. Please log into the CareFirst Advantage DualPrime Provider Portal and click on the Resources Tab.