Pediatric Coding Alert

Question: One of our private insurers is requiring us to append modifier CS to all line items for the prevention, identification, diagnosis or treatment of COVID-19. So, if my provider administers a nebulizer treatment, flu test, or strep test to help with breathing or to determine the patient’s illness, do I append CS to these items?

Oregon Subscriber

Answer: Medicare, and payers following their guidelines, requires modifier CS (Cost-sharing for specified covid-19 testing-related services that result in an order for or administration of a covid-19 test) to be appended to any evaluation and management (E/M) service that results in the provider either administering or ordering a COVID-19 lab test for the patient.

In other words, if the E/M leads to either 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) or 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) being ordered, then the CS modifier is appended to the E/M according to AAPC (Source: www.aapc.com/blog/50329-waive-cost-sharing-on-applicable-claims-using-modifier-cs/). Additionally, if your practice performs the test, you can append modifier CS to that service as well.

However, you would not append the modifier to any other line item that do not qualify as COVID-19-related. This would include the nebulizer treatment, flu test, or strep test that your provider administered, as they are not related to a COVID-19 diagnosis.