What coding modifiers to use for telehealth services and COVID-19 testing – Medicare Guide

modifiers to use for telehealth services and COVID-19 testing

Administrative changes identified with COVID-19 are flying at a quick pace nowadays and probably the latest changes influence how you should code for telehealth administrations and COVID-19 testing when charging Medicare.

Arrangements inside the Families First Coronavirus Response Act (FFCRA) and the Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Interim Final Rule influence Medicare Part B installment during the COVID-19 Public Health Emergency.

The FFCRA postpones cost-sharing for COVID-19 testing-related administrations for Medicare Part B patients. Cost-sharing is deferred for office visits that bring about the request or organization of the COVID-19 test, or the assessment of a person to decide the requirement for such a test. The cost-sharing waiver is powerful for dates of administration beginning March 18, 2020, until the finish of the general wellbeing crisis.

Doctors should utilize the – CS modifier on relevant claims to distinguish the administration subject to the cost-sharing waiver. Medicare recipients ought not to be charged for any coinsurance or deductible for those administrations. The – CS modifier will flag the Medicare Administrative Contractors (MACs) to pay 100% of the permissible expense for the administration. Doctors should contact their MACs and solicitation to resubmit pertinent cases with dates of administration on or after March 18, 2020, that were submitted without the – CS modifier. The – CS modifier ought not to be utilized for administrations inconsequential to COVID-19.

The Interim Final Rule refreshes installment strategies to permit doctors to be paid at the non-office rate for Medicare telehealth administrations. During the COVID-19 emergency, Medicare will pay the non-office sum for telehealth administrations when they are charged with the spot of administration (POS) the doctor would have utilized if the administration had been given face to face (e.g., POS 11 – Office). Doctors ought to affix modifier – 95 to the case lines conveyed by means of telehealth. Cases with POS 02 – Telehealth will be paid at the ordinary office rate, which is ordinarily not exactly the non-office rate under the Medicare doctor expense plan.

Extra data on charging for telehealth administrations is accessible on the American Academy of Family Physicians’ (AAFP) COVID-19: Telehealth Tools page.

The following table provides a summary of the POS and modifier requirements for Medicare Part B.

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


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


Commercial payers are generally following Medicare’s lead in terms of coverage and policy. However, coding guidance varies from payer to payer. The AAFP is tracking payer policies closely. A table of private payer policies and list of frequently asked questions are available on the Academy’s COVID-19: Practice Management Page.

One final note: Appropriate diagnosis coding can help further distinguish services related to COVID-19. The Centers for Disease Control and Prevention has updated the ICD-10-CM official coding and reporting guidelines(www.cdc.gov) to address COVID-19 diagnosis and exposure coding.

— Information is based on the article posted by Erin Solis, Manager, Practice & Payment at the AAFP


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