Knowledge Base Article

Q:

What COVID-19 testing-related services are eligible for waiving cost-sharing and how are they identified in Medicare claims?

A:

CMS provided the following information in the Thursday, August 27, 2020 edition of MLNConnects:

The Families First Coronavirus Response Act waives cost-sharing under Medicare Part B (coinsurance and deductible amounts) for COVID-19 testing-related services through the end of the public health emergency. In April, CMS provided evaluation and management categories for applicable medical visits. We are now specifying HCPCS procedure codes for this cost-sharing waiver for:

• Physicians/Non-Physician Practitioners (ZIP)
• Hospital Outpatient Departments paid under the Outpatient Prospective Payment System (PDF)
• Rural Health Clinics and Federally Qualified Health Centers (ZIP)
• Critical Access Hospitals (CAHs) use the Outpatient list; Method II CAHs use the Outpatient and Physicians/Non-Physician Practitioners lists as applicable

Use the Cost Sharing (CS) modifier on applicable claim lines to identify the service as subject to this cost-sharing wavier. If you use the CS modifier with HCPCS codes that are not on the list, we will return the claim.

For more information, see MLN Matters Special Edition Article SE20011 Medicare Fee-For-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) (PDF).

Resource:

Thursday, August 27, 2020 edition MLNConnects:

https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-08-27-mlnc#_Toc49329805