Pulmonology 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?

Tennessee 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 code. Additionally, if your practice performs the test, you can append modifier CS to that service as well.

Also remember that some payers are waiving cost-sharing for all telemedicine services regardless of the COVID-19 diagnosis or testing to remove barriers for their patients. Check with your payers to determine whether they might want you to use the CS modifier on other services when patients are utilizing telemedicine services.