CareFirst BlueCross BlueShield Mental Health Coverage Guide
CareFirst BlueCross BlueShield is the largest health insurer in the Maryland, Washington, D.C., and northern Virginia region, serving approximately 3.5 million members. They are a major provider of employer-sponsored, individual, and Medicare plans in the capital region.
BlueCard Network Access
As a Blue Cross Blue Shield member, you have access to the BlueCard program, which lets you see in-network providers across state lines. This is especially helpful if you travel frequently or live near a state border.
How to Verify Your Mental Health Benefits
Before your first appointment, verify your specific benefits so you know what to expect. Here is a step-by-step process for CareFirst BlueCross BlueShield members:
- Call 1-800-544-8703 and have your member ID card ready.
- Ask to speak with the behavioral health benefits department.
- Ask: "What is my deductible for outpatient mental health services, and how much have I met?"
- Ask: "What is my copay or coinsurance for an in-network therapy session?"
- Ask: "Do I have out-of-network benefits, and what is the reimbursement rate?"
- Ask: "Is prior authorization required for outpatient therapy?"
- Ask: "Is there a session limit per year?"
- Ask: "Are telehealth sessions covered at the same rate as in-person?"
Know Your Rights: Mental Health Parity Act
Federal law requires CareFirst BlueCross BlueShield to cover mental health services at the same level as medical and surgical benefits. If you are denied coverage, ask for the denial in writing and reference the Mental Health Parity and Addiction Equity Act.
Want to keep track of all these details? Use our free benefits verification worksheet to organize your coverage information.
Finding an In-Network Therapist
Search CareFirst BlueCross BlueShield's provider directory directly: Find a therapist in your area
Tips for Using the CareFirst BlueCross BlueShield Directory
- Filter by "Behavioral Health" or "Mental Health" specialty.
- Check that the provider is accepting new patients before calling.
- Confirm the provider is in-network for your specific plan (not just CareFirst BlueCross BlueShield generally).
- Look for providers who specialize in your specific concern (anxiety, depression, trauma, etc.).
Types of Providers Covered
Telehealth Coverage
CareFirst BlueCross BlueShield covers telehealth therapy sessions, so you can meet with a therapist from home via video or phone.
Couples & Family Therapy
Family therapy covered with a clinical diagnosis under CPT 90847.
Understanding Your CareFirst BlueCross BlueShield Coverage
Available Plan Types
Behavioral Health Managed By
CareFirst Behavioral Health
Some CareFirst BlueCross BlueShield plans outsource behavioral health management. You may need to call the behavioral health manager directly for authorizations and provider searches.
Prior Authorization
Not required for outpatient therapy. Required for inpatient psychiatric admissions and residential treatment.
Substance Use Treatment
CareFirst BlueCross BlueShield covers substance use disorder treatment, including outpatient counseling, intensive outpatient programs, and inpatient rehabilitation.
Employee Assistance Program (EAP)
CareFirst offers employer-sponsored EAP programs.
Common CPT Codes for Therapy
These are the billing codes your therapist will use when filing claims with CareFirst BlueCross BlueShield:
| CPT Code | Description |
|---|---|
| 90791 | Psychiatric diagnostic evaluation |
| 90834 | Individual therapy (45 minutes) |
| 90837 | Individual therapy (60 minutes) |
| 90847 | Family / couples therapy (with patient present) |
| 90846 | Family therapy (without patient present) |
| 90853 | Group therapy |
How to Get Reimbursed (Out-of-Network)
If you are seeing a therapist who is not in CareFirst BlueCross BlueShield's network, you may still be able to get reimbursed. Here is how:
- Pay your therapist directly at the time of your session.
- Request a superbill from your therapist after each session. This is a detailed receipt with the information CareFirst BlueCross BlueShield needs to process your claim.
- Submit your claim to CareFirst BlueCross BlueShield using one of these methods:
- Online: Submit through the member portal
- Mobile App: Submit via the CareFirst BlueCross BlueShield app
- Fax: 1-410-581-3222
- Mail: CareFirst BlueCross BlueShield, P.O. Box 17547, Baltimore, MD 21297-1547
- Wait for processing. Most claims are processed within 30 days. You will receive an Explanation of Benefits (EOB) showing what was covered.
CareFirst BlueCross BlueShield Claims Note
Use the CareFirst member app or My Account portal for claims.
What Your Superbill Should Include
- Therapist's name, credentials, NPI number, and tax ID
- Date of service
- CPT code (e.g., 90834 or 90837)
- ICD-10 diagnosis code
- Amount charged
- Your name and date of birth
CareFirst BlueCross BlueShield tip: Submit superbills through the My Account portal at member.carefirst.com. Include your member ID and group number. Claims are typically processed within 30 days.
Save Money on Therapy with CareFirst BlueCross BlueShield
Use Your HSA or FSA
Therapy is an eligible expense for Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). You can use these pre-tax dollars to pay for copays, coinsurance, and out-of-network therapy costs, effectively saving 20-35% on your therapy expenses.
Ask About Sliding Scale Fees
Many therapists offer reduced rates based on your income. If you have a high deductible CareFirst BlueCross BlueShieldplan or high out-of-pocket costs, ask your therapist about sliding scale options. Some therapists will also offer "single-case agreements" with CareFirst BlueCross BlueShield at a negotiated rate.