Why and when should we use modifier CS?
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.
According to Optum 360° and the APTA, therapeutic activities require the "use of dynamic activities to improve functional performance."
When considering whether the activity you are having the patient perform is classified as a therapeutic activity or if it falls under a different category, here are some questions to ask yourself:
Is this a functional activity, such as climbing stairs?
Will this improve his/her functional performance, in daily life, at work, or in a sport?
Is more than one parameter (strength, coordination, etc.) being addressed with this activity?
Does this activity directly correspond or relate to a specific work or sports task that the patient will be performing once they have fully recovered?
If you answered yes to any of the above questions, then you would bill 97530 for therapeutic activities. Therapeutic activities cover a wide range of functional activities, such as squatting, ascending/descending stairs, walking, bending, lifting, catching, throwing, pushing, pulling, etc. It is important to note that Medicaid plans only pay for 97530 codes and do not pay for 97110 therefore it should always be verified prior to seeing a patient
Therapeutic activities also tend to incorporate the use of multiple parameters (balance, coordination, power, strength, range of motion, etc.) into one activity/exercise. When documenting, be sure to document the specific relationship to a functional activity and how it applies to that particular patient.