Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has updated its coding guidance for our coverage of and cost-share waiver for a doctor visit or call to determine if COVID-19 testing is necessary.
Effective Aug. 1, 2020, providers should use the -CS modifier to indicate any COVID-19 testing-related services that result in an order for or administration of a COVID-19 test:
- The -CS modifier should be applied to diagnostic imaging, labs and physician encounters (both face-to-face and telehealth) to determine if testing is needed for individuals with COVID-19 symptoms.
- Please do not use the -CS modifier if you are screening a patient for COVID-19 (i.e., pre-op testing services). The modifier only should be used for visits and services to determine if COVID-19 testing is necessary.
- The -CS modifier is not required for the COVID-19 test itself.
- If another modifier is required for reimbursement purposes (e.g. -26 on a radiology procedure or -CR to indicate audio only for a commercial telehealth visit), the -CS modifier may be placed in the second or third position.
- The addition of the -CS modifier does not apply to treatment of COVID-19 or any other diagnosis.
- This coding guidance applies to Blue Cross NC fully-insured, State Health Plan, and Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health. Blue Cross NC will be consulting with self-insured employer groups regarding revising their benefits.
- For additional coding guidance, click here.
As a reminder, Blue Cross NC will provide coverage and waive cost-sharing (including deductibles, copayments, and coinsurance) for COVID-19 testing or for a doctor visit or call to determine if testing is necessary. Specifically, there will be no member cost-share for COVID-19 testing or clinical visits to determine if testing is needed through virtual care visits, outpatient office visits, urgent care visits or ER visits. These changes are in line with the federal coronavirus relief package approved and signed into law on March 18, 2020. We continue to encourage the use of virtual visits as the first step to seeking testing. For guidance on COVID-19 testing, please visit the CDC website.
For the cost-share waiver to apply, COVID-19 testing methods must meet the following criteria:
- Ordered by a licensed health care provider,
- Determined as medically necessary by a licensed health care provider for the diagnosis and management of a member’s medical condition, and
- Have been cleared, approved or given emergency use authorization (EUA) by the FDA
For more information, visit the Blue Cross NC provider coronavirus page at www.bluecrossnc.com/coronavirus-providers.