Basic of CS & 95 modifier

Through the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), cost-sharing for COVID-19 testing and related services has been waived for insured patients from March 18, 2020, through the end of the COVID-19 Public Health Emergency (PHE).

Physicians should use the -CS modifier on applicable claims to identify the service subject to the cost-sharing waiver. Medicare beneficiaries should not be charged for any coinsurance or deductible for those services. The -CS modifier will signal the Medicare Administrative Contractors (MACs) to pay 100% of the allowable cost for the service. Physicians should contact their MACs and request to resubmit applicable claims with dates of service on or after March 18, 2020, that were submitted without the -CS modifier. The -CS modifier should not be used for services unrelated to COVID-19.

For services furnished on 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 wavier for COVID-19 testing-related services and should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services.

Physicians should append modifier -95 to the claim lines delivered via telehealth. Claims with POS 02 – Telehealth will be paid at the normal facility rate, which is typically less than the non-facility rate under the Medicare physician fee schedule.

Service	Place of Service	Modifier(s)
Office visit related to COVID-19 testing	11 – Office	-CS
Telehealth visit related to COVID-19 testing	11 – Office	-95
Telehealth visit related to COVID-19 testing	11 – Office	-CS
Office visit not related to COVID-19	11 – Office	None
Telehealth visit not related to COVID-19	11 – Office	-95
Virtual Check-In (HCPCS G2012, G2010)	11 – Office	None
E-Visit (CPT 99421-99423)	11 – Office	None
Telephone Evaluation and Management (CPT 99441-99443)	11 – Office	None

CS modifier is applicable for COVID-19 Lab test CPT code 87635 and below E&M category 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

For labs or other providers billing for COVID-19 tests, use one of the three codes available:

U0001 – HCPCS code for COVID-19 tests developed by the Centers for Disease Control and Prevention (CDC)
U0002 – HCPCS code for COVID-19 tests developed by labs other than the CDC
87635 – CPT code for COVID-19 tests