The CS modifier should be applied for certain evaluation and management services related to COVID-19 testing, whether they are furnished in person or via telehealth. These services are medical visits for the HCPCS evaluation and management categories described below when an outpatient provider, physician, or other providers and suppliers that bill Medicare for Part B services orders or administers COVID-19 lab test U0001, U0002, or 87635. Cost-sharing does not apply for COVID-19 testing-related services, which are medical visits that: are furnished between March 18, 2020, and the end of the PHE; result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test; and are in any of the following categories of HCPCS evaluation and management codes:

• Office and other outpatient services

• Hospital observation services

• Emergency department services

• Nursing facility services

• Domiciliary, rest home, or custodial care services

• Home services

• Online digital evaluation and management services

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Cost-sharing does not apply to the above medical visit services for which payment is made to:

• Hospital Outpatient Departments paid under the Outpatient Prospective Payment System

• Physicians and other professionals under the Physician Fee Schedule

• Critical Access Hospitals (CAHs)

• Rural Health Clinics (RHCs)

• Federally Qualified Health Centers (FQHCs)

 

For services furnished on or after March 18, 2020, and through the end of the PHE, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under these payment systems should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19 testing-related services and should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services. Additionally, the CPT telehealth modifier, modifier 95, should be applied to claim lines that describe services furnished via telehealth. And the billing practitioner should report the POS code that reflects the place the service would have been furnished if furnished inperson.

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Link:https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf

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COVID-19 VACCINE TIPS AND GUIDELINES

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Appendix Q: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) Vaccines

 

This table links the individual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine product codes (91300, 91301) to their associated immunization administration codes (0001A, 0002A, 0011A, 0012A), manufacturer name, vaccine name(s), 10 and 11-digit National Drug Code (NDC) Labeler Product ID, and interval between doses.

 

These codes are also located in the Medicine section of the CPT code set.

 

Additional introductory and instructional information for codes 0001A, 0002A, 0011A, 0012A and 91300, 91301 can be found in the Immunization Administration for Vaccines/Toxoids and Vaccines, Toxoids guidelines in the Medicine section of the CPT code set.

 

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