Urology 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 that “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: The guidelines for this specific payer state that they want modifier CS appended to both the E/M and the COVID-19 testing, when applicable. The Centers for Medicare & Medicaid Services (CMS) initially published guidelines that advised that you only append modifier CS to E/M claims. Other commercial payers have since released their own guidelines that outline that you append modifier CS to both the respective testing code and E/M service.

However, keep in mind that if the patient is swabbed during an E/M visit, then the nasal swab will be included in the E/M code. If the patient presents to the physician’s office for a presurgical nasal swab, then you may report codes 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional…) and 99000 (Handling and/or conveyance of specimen for transfer from the office to a laboratory). You should append modifier CS to each of these codes.