Why and when to use Modifier CS

Question:

Why and when should we use modifier CS?

Answer:

Use modifier CS on visits related to testing for COVID-19.

Modifier CS: cost sharing waiver for COVID-19 testing

When you do, Medicare and private insurers will pay 100% of the claim, without any patient due cost sharing. The two laws that were passed require Medicare and commercial plans to cover these services without any cost sharing requirements or prior authorization or other medical management requirements.

Modifier CS was effective March 18, 2020 and is in effect until the end of the public health emergency.

• The service results in an order for or administration of a COVID-19 test
• The service is related to furnishing or administering the test
• The service is for the evaluation to determine if the patient needs a COVID-19 test

Use this modifier on these categories of codes:

• Office and other outpatient services
• Observation services
• ED visits
• Nursing facility services
• Domiciliary, rest home, or custodial services
• Home services
• Online digital E/M services

Medical visit services for payments made to:

• Hospital outpatient departments paid under the OPPS system
• Medical services paid under the physician fee schedule
• Critical access hospitals
• Rural health centers
• Federally qualified health centers.

You can use modifier CS on both in-person visits and visits via telehealth. If using modifier 95, for telehealth services, I suggest reporting it like this: 99214 -CS -95. Modifier CS affects payment, so use it first. Modifier 95 is informational.

It is not for use when treating Covid, unfortunately.

You can read more about modifier CS here.

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