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April 7, 2020

Medicare Cost-sharing Waived for all COVID-19 Services Related to Testing, Including Some Treatment

The Centers for Medicare & Medicaid Services (CMS) released guidance implementing a provision of the Families First Coronavirus Response Act that waives cost-sharing for COVID-19 testing-related services. Specifically, CMS will waive Medicare beneficiaries’ cost-sharing (coinsurance and deductible) for all services that result in an order for or administration of a COVID-19 test, are related to administering such a test, or to the evaluation of an individual for purposes of determining the need for such a test. This includes emergency department evaluation and management (E/M) services, hospital observation services, and office and other outpatient services.

For each applicable claim, you should use the “CS modifier” and should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services. The policy is RETROACTIVE to March 18 and lasts through the end of the COVID-19 national emergency. Thus, if you already have submitted eligible claims after March 18 without the CS modifier, you can contact your local Medicare Administrative Contractor (MAC) and request to resubmit the claims with the CS modifier to get 100 percent payment. 

It is important to note that the Families First Coronavirus Response Act cost-sharing waiver of COVID-19 testing-related services applies to all insurers, not just to Medicare. ACEP will carefully track how each private payor is implementing this important patient protection.

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