decisionhealth Newsletters, Coder Pink Sheets - 2020 Issue 6 (June)
Attach a modifier to your COVID-19 testing-related E/M claims, CMS says
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Article Overview
This article covers CMS guidance issued in April about billing for COVID-19 testing-related encounters during the public health emergency. It is aimed at physicians, practitioners, hospitals, and other Medicare billing staff who need to understand the affected claim types, the time period involved, the broad categories of eligible services, and the resubmission steps CMS described for claims filed without the modifier. The article also places the guidance in a broader emergency-policy context.
Why This Topic Matters
The guidance affects whether certain Medicare claims are processed at full payment during the COVID-19 emergency and helps billing teams identify which claims may need review or correction.
Article Sections
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CMS guidance on COVID-19 testing-related claims
Overview of the CMS communication and the Medicare billing context for COVID-19 testing-related encounters.
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Application of the modifier to eligible encounters
Discussion of the affected service category, the timeframe for use, and the general types of encounters referenced by CMS.
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Questions about claim handling and resubmission
Information on how CMS said certain previously submitted claims should be handled and resubmitted if needed.
What You Will Learn
- How CMS framed billing guidance for COVID-19 testing-related encounters
- Which broad categories of Medicare services were discussed in relation to the guidance
- What time period CMS tied to the emergency-era billing policy
- How the article addresses claim resubmission and follow-up with Medicare contractors
- How CMS positioned the guidance within earlier emergency-related use of the modifier
Who Should Read This
- Physicians
- Practitioners
- Medical coders
- Billing staff
- Revenue cycle staff
- Hospital coding departments
- Medicare claims processors
Codes Discussed
Modifiers Discussed
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