Otolaryngology Coding Alert

Question: Our payer has a guideline regarding modifier CS (Cost-sharing for specified covid-19 testing-related services that result in an order for or administration of a covid-19 test) that states: “Modifier CS must be added to each line item for COVID-19-related testing or treatment.” We had a patient come in and receive treatment for respiratory conditions affecting the throat and lungs. The physician suspects COVID-19, but only a nebulizer, flu test, and strep test were performed. Should we append modifier CS to these services?

Delaware Subscriber

Answer: The guidelines for this specific payer state that they want modifier CS appended to both the evaluation and management (E/M) and the COVID-19 testing, when applicable. However, you’ve got to look closely at the guidelines that state that “Modifier CS must be added to each line item for COVID-19-related testing or treatment.” A nebulizer, flu test, or strep test do not qualify as COVID-19-related. Therefore, you should not be appending modifier CS to each of those respective codes.

If the physician submitted an order that the patient receive a COVID-19 test, then modifier CS can be appended to the E/M code for the office/outpatient visit. Furthermore, if the COVID-19 test is performed in the office, these payer guidelines state that modifier CS should be appended to that code, as well. However, if no COVID-19 test was ordered, this encounter does not warrant adding modifier CS to any portion of the claim.