Note: These tables are informational, not advisory. The AAFP recommends that physicians verify each payer's policy and ask patients to verify their coverage ahead of appointments.
Aetna | Anthem* | Cigna | Humana |
UHC |
Medicare | |
---|---|---|---|---|---|---|
CPT Codes: 99201-99205, 99211-99215 | ||||||
Place of Service (POS) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) | Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Modifier |
The AAFP is seeking additional information. |
-CS *Must use appropriate ICD-10 code (Z03.818 or Z20.828) |
-CS |
-CS |
-CS |
|
Cost-share waiver |
Yes |
Yes |
Yes |
Yes. |
Yes |
Yes |
Cover cost-share |
Yes |
Yes |
Yes. |
Yes |
Yes |
*Anthem's policies vary by state; contact your provider-relations representative.
Aetna | Anthem | Cigna | Humana |
UHC |
Medicare | |
---|---|---|---|---|---|---|
CPT Codes: 99201-99205, 99211-99215 | ||||||
Place of Service (POS) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) | Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Modifier |
None |
None |
None |
None |
None |
None |
Cost-share waiver |
No |
No |
No |
No |
Yes* |
No |
Cover cost-share |
N/A |
N/A |
N/A |
N/A |
Yes* |
N/A |
*Applies to Medicare Advantage members only
Medicare and most national payers will cover pay the full contracted/allowable amount when cost-sharing is waived. The “CS” modifier is required to trigger full payment of the full allowed amount. Claims missing the “CS” modifier may not be paid at the full allowed amount.
COVID-related services include:
COVID-19-related services should be assigned the appropriate COVID-19 ICD-10 diagnosis code. Coding guidance can be found on the CDC website. Cost-sharing waivers may not be applied to claims that do not include an appropriate COVID-19 ICD-10 diagnosis code.
Self-funded plans can develop their own policies and may opt out of some cost-sharing waivers. Similarly, Medicaid policies are established at the state-level. The AAFP recommends contacting your provider-relations representatives or Medicare Administrative Contractors to verify policies. The Center for Connected Health Policy is tracking COVID-19-related state actions.