Wiki Copays not being waived when using U07.1....

[nneecole44]

We just started getting EOB's for BCBS and UHC not waiving co-pays for positive Covid 19 (U07.1) patient's office visits. Up until now. If a patient was seen and tested for Covid. We used the CS modifer with U07.1 (if positive) and Z20.828 if exposed. All of a sudden they are not waiving the copays if we use the U07.1 diagnosis. I have scoured their web sites. Is anyone else having this happen?? Thank you.

 

[csperoni]

We don't treat Covid, but my understanding was that the copay is waived only for testing/decision to test (modifier CS) during the PHE (currently until 01/20/2021 but I expect it will be extended.) If the visit was to treat Covid, -CS does not apply.
I found this on the UHC website https://www.uhcprovider.com/en/reso...covid19-testing/covid19-testing-guidance.html They specify it must be an FDA approved test to qualify for cost share waiver. BCBS carriers vary by state.
I also believe self funded plans can opt out of the cost share waiver.
I would suggest calling the carrier, or submitting on online claim review request.