Jan. 27, 2021, update – We have received inquiries regarding the use of the -CS modifier for Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health. As a reminder, please follow these guidelines for these members:

• Providers should continue to follow CMS guidelines for use of the -CS modifier for Blue Medicare and Experience Health members. Use the HCPCS codes for billing the -CS modifier in MLN - SE20011 under the section labeled Families First Coronavirus Response Act Waives Coinsurance and Deductibles for Additional COVID-19 Related Services (PDF). Please only use the -CS modifier on the codes listed in the links in the MLN. The links have files with codes and those are the only codes that should have modifier CS applied.
  
• Additionally, providers should not apply the -CS modifier to any COVID-19 lab or administration codes for Experience Health and Blue Medicare members. These services do not have a member liability during the pandemic and do not require the modifier. If the -CS modifier is applied to a COVID-19 lab service, the claim will deny.

The article below was originally posted on Jan. 20, 2021.

We held another session of Blue Cross NC COVID-19 Virtual Rounds on Jan. 11, 2021. See below for updates from our most recent webinar:

Please note: Based on feedback from providers after the Jan. 11 Virtual Rounds, we have adjusted our coding guidance for commercial claims for clinical visits to determine if COVID-19 testing is necessary. 

• For dates of service on or after Feb. 1, 2021, you have three options to indicate waiving cost share for commercial claims. It is at the discretion of the provider to choose which is appropriate.  
  
  • -CS modifier: Can be used to indicate diagnostic imaging, labs and physician encounters (both face-to-face and telehealth) to determine if COVID-19 testing is needed for a patient who has a confirmed or suspected exposure to COVID-19.
    
  • Z20.822: Contact with and (suspected) exposure to COVID-19 
    
    • Likely will capture the majority of encounters 
      
    • Place as the primary diagnosis on the claim line when contact/exposure is the reason for the encounter and the patient is asymptomatic 
      
  • Z11.52: Encounter for screening for COVID-19 
    
    • Can be used as the primary diagnosis on the claim line when screening is the reason for the encounter and the patient is asymptomatic 
      
• Reminders: 
  
  • Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health, should continue to follow CMS guidelines for use of the -CS modifier. 
    
  • Providers should use the number on the back of a patient’s ID card to verify benefits for other Blues plans as not all are waiving cost share in the same way that Blue Cross NC is. 
    
  • For additional guidance, please visit our Details and Coding Guidance page.
    

Given the nature of the pandemic, policies have been evolving and have required updating, which is why we are unable to post the audio of the webinar. However, you can download the updated FAQs and slides from the session to review the updates we provided.

We also encourage you to sign up for the Monday, Feb. 15, 2021, edition of Virtual Rounds. (Please note: If you previously selected to have the option to attend all future sessions, you do not need to sign up again.)

Please note that we have been experiencing a high volume of inquiries. Most questions can be answered through the materials that have already been posted or are now updated with more complete information. If you have questions, we ask that you first review the resources on our dedicated coronavirus site for providers at www.bluecrossnc.com/coronavirus-providers.

If you cannot find answers there, please use the following:

• For general questions: Call the Provider Blue Line at 800-214-4844 from 8 a.m. to 5 p.m., Monday - Thursday and 8 a.m. to 4 p.m. on Fridays. We also encourage you to join us during a future “Virtual Rounds” session.
  
• For claims-related questions: Fill out this form. Someone from our claims escalation team will respond within 10 business days. If it’s been more than 10 business days, please follow up send an email with the claim ID to covid19claimsfallout@bcbsnc.com.
  

For questions about FEP or other Blues plans: Visit the FEP website or the Blue Cross Blue Shield Association website.