Wiki Modifier CS

[Bhignojos]

Are we to apply modifier CS to the E/M service only, or do we apply it to the COVID test and related tests ordered due to COVID?

Thanks!

 

[Mayzoo]

Looks like the answer is, as usual, depends:

https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-10-mlnc-se

"Using CS Modifier When Cost-Sharing is Waived
This clarifies a prior message that appeared in our April 7, 2020 Special Edition.

CMS now waives cost-sharing (coinsurance and deductible amounts) under Medicare Part B for Medicare patients for certain COVID-19 testing-related services. Previously, CMS made available the CS modifier for the gulf oil spill in 2010; however, CMS recently repurposed the CS modifier for COVID-19 purposes. Now, for services furnished on March 18, 2020, and through the end of the Public Health Emergency, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under specific payment systems outlined in the April 7 message should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and to get 100% of the Medicare-approved amount. Additionally, they should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services."

https://www.aapc.com/blog/50329-waive-cost-sharing-on-applicable-claims-using-modifier-cs/

"Note: The American Medical Association released two new testing CPT® codes after CMS published the MLN Connects SE: 86328 and 86769. As such, CMS does not address these codes in the provider education.

CMS further outlines that cost sharing is waived for qualifying E/M services dated March 18 through the end of the public health emergency. This guideline applies to any of the following E/M services, so long as the criteria for the visit is met:

• Office and other outpatient services
• Hospital observation services
• Emergency department services
• Nursing facility services
• Domiciliary, rest home, or custodial care services
• Home services
• Online digital evaluation and management services

Furthermore, cost sharing is waived for a qualifying E/M service to any of the following:

• Hospital outpatient departments paid under the outpatient prospective payment system
• Physicians and other professionals under the physician fee schedule
• Critical access hospitals
• Rural health clinics
• Federally qualified health centers"

 

[Bhignojos]

Thank you!

 

[jgargiulo]

HI to follow up to CS modifer in an urgent care setting does it require the "CS" to be processed at 100%. More specifically Aetna Health Care

 

[ajohnsondavis109]

For RHC's can you billed modifier CS with CG on an E/M?

 

[jbhuju]

what about FQHC? do we still use CS modifier if the visit is related to covid 19?