Claims with CS modifier will be denied starting July 28

Effective July 28, 2025, claims submitted with the CS modifier will be denied. You’ll see denial code “E1J – Modifier used inappropriately” in prism.

Background

In alignment with CMS policy, we required CS modifier use during the COVID-19 public health emergency (PHE) to waive member cost-sharing for:

• Specified COVID-19 testing-related services that resulted in an order for, or administration of, a COVID-19 test
• Preventive services provided via telehealth in Rural Health Clinics and Federally Qualified Health Centers

The COVID-19 PHE ended on May 11, 2023, and we’re now updating our system to reflect that.

What else do you need to know?

You can reference the following for more information: COVID-19 Public Health Emergency (US Department of Health and Human Services).