CMS finally specifies which service codes are subject to COVID-19 cost-sharing waiver

After several months, the Centers for Medicare & Medicaid Services (CMS) has finally released a list of specific procedure codes that are subject to rules waiving coinsurance and deductibles for COVID-19 testing.

The Families First Coronavirus Response Act eliminated cost-sharing under Medicare Part B for COVID-19 testing-related services through the end of the public health emergency. CMS provided general guidance in April about which categories of services would be subject to the cost-sharing waiver. But now CMS has posted lists of the specific CPT and HCPCS codes.

There are separate lists for physicians/non-physician practitioners, hospital outpatient departments, and rural health clinics and federally qualified health centers. Critical access hospitals (CAHs) will use the hospital outpatient list, while Method II CAHs use the hospital outpatient and physicians/non-physician practitioners lists as applicable.

You should 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 service codes that are not on the list, Medicare will return the claim.

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

— Kent Moore, Senior Strategist for Physician Payment, American Academy of Family Physicians