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Pulmonology Coding Alert

You Be the Coder:

Do You Know When Modifier CS Applies?

Question: We recently received a bulletin about modifier CS, but it was confusing and we aren’t sure whether we should be appending this modifier to anything. Can you explain the point of it?

New Mexico Subscriber

Answer: Modifier CS represents “Cost-sharing for specified covid-19 testing-related services that result in an order for or administration of a covid-19 test,” and you’ll find information about this modifier in a special edition of MLN Connects released on April 7, 2020. CMS covered a wide variety of subjects including some new details on the Families First Coronavirus Response Act. According to CMS, the implementation of this act “waives cost-sharing under Medicare Part B (coinsurance and deductible amounts) for Medicare patients for COVID-19 testing-related services.”

The following guidelines pertain to E/M services that led to the administration or ordering of COVID-19 lab tests by an outpatient provider, physician, or “other providers and suppliers billing under Medicare Part B.” This means that, in order to waive cost-sharing, the E/M visit must result in one of the following COVID-19 lab tests being ordered or performed:

  • U0001 (CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel)
  • U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc)
  • 87635 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique)

For the aforementioned services that are billed to their respective payment systems, CMS explains that you should append modifier CS “on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services.” In addition, CMS advises that “you should NOT charge Medicare patients any co-insurance and/ or deductible amounts for those services.”

Providers may also retroactively resubmit applicable professional claims with modifier CS from March 18 and beyond so long as they contact their MACs beforehand. Institutional claims may also be resubmitted with modifier CS appended to receive 100 percent of payment.