Primary Care Coding Alert

Question: Our payer has a guideline that states: “Modifier CS must be added to each line item for COVID-19-related testing or treatment.” Does that mean that this applies to both the COVID-19 testing and the evaluation and management (E/M) code?

Kansas Subscriber

Answer: Medicare, and payers following its 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 both the E/M and the COVID-19 testing, when applicable.

In other words, if the E/M leads your provider to order 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), 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. If not, then you may also report 99000 (Handling and/or conveyance of specimen for transfer from the office to a laboratory), if applicable, and apply the CS modifier to the specimen handling code. However, if the patient is swabbed during the E/M visit, then the nasal swab will be included in the E/M code. And you would not append the modifier to any other line items that result from the E/M but that do not qualify as COVID-19-related.