CMS Waives Part B Cost Sharing for More Services

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Cost Sharing


CMS Waives Part B Cost Sharing for More Services

Are you working off the latest list of codes applicable for modifier CS?

During the public health emergency (PHE) for COVID-19, patients’ Medicare Part B cost sharing (coinsurance and deductible) is waived for certain healthcare services. The Centers for Medicare & Medicaid Services (CMS) maintains a list of codes to which the cost-sharing waiver applies, and the list just got a little longer. CMS has added three CPT® and three HCPCS Level II codes to the list of services applicable for the cost-sharing waiver. There are now 212 codes for which cost sharing does not apply when the service is integral to COVID-19 testing-related services.

Which Services Apply for the Cost-Sharing Waiver?

Per the Feb. 11 MLN Connects®, “Effective March 18, 2020, the Families First Coronavirus Response Act requires Medicare Part B to cover beneficiary cost-sharing for provider visits when a COVID-19 diagnostic test is administered or ordered.”

CMS clarifies in MLN Matters SE20011 Revised, Nov. 9, 2020, that patient cost sharing does not apply when:

  • Medical visits result in an order for or administration of a COVID-19 test; or
  • Medical visits are related to furnishing or administering a COVID-19 test; or
  • Medical visits are for the evaluation of patient for purposes of determining the need for a COVID-19 test.

Remember: Append modifier CS to applicable evaluation and management (E/M) services related to COVID-19 testing furnished in person or via telehealth by a physician or other qualified healthcare professional in an applicable healthcare setting.

Do not append modifier CS to services that include COVID-19 testing when the service is within the global period of another service and, therefore, not paid separately. For example, you would not append modifier to a pre-op visit that includes a COVID-19 test when the pre-op visit is performed within the global period of the surgery.

More Codes Apply to Cost-Sharing Waiver

The following codes apply for the cost-sharing waiver effective Jan. 1, 2021, through the end of the PHE, currently April 20:

G2250 Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
G2251 Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
G2252 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
98970 Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
98971 Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
98972 Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
Note that 98970-98972 replace G2061-G2063.

Download the complete list of codes for physician and nonphysician practitioner services from the CMS website. (There are separate lists for claims paid under the Outpatient Prospective Payment System and rural health clinics and federally qualified health centers.)


Source: MLN Connects, Thurs., Feb. 11, 2021

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