Medicare Compliance & Reimbursement

If your coding staff are used to adding the CR modifier and the DR code to claims associated with the COVID-19 public health emergency (PHE), get ready for that to end on May 11.

Reminder: The CR modifier (Catastrophe/disaster related) and DR condition code (disaster related) are required after a PHE is declared and formal waivers ensue. This is mandated by Section 1135 of the Social Security Act and outlined in the Medicare Claims Processing Manual, Chapter 38, Section 10.

In 2020, the Centers for Medicare & Medicaid Services (CMS) added insight on the modifier and code usage for Medicare claims in its COVID-19 Frequently Asked Questions (FAQs) set on fee-for-service (FFS) billing. The DR condition code applies to institutional providers only “when all of the services/items billed on the claim are related to a COVID-19 waiver,” according to the guidance. Both institutional and non-institutional providers should append the CR modifier for Part B line items/services in connection with COVID-19 waivers, CMS instructs.

Now: As the COVID PHE is expected to end on May 11, providers may want to review the policies now, CMS advises. “Since the CR modifier and DR condition code should only be reported during a PHE when a formal waiver is in place, plan to discontinue using them for claims with dates of service on or after May 12, 2023,” the agency reminds in a March 16 MLN Connects update.

Don’t forget: As you update your post-PHE policies, remember to review CMS guidance on the COVID waivers and flexibilities across the various parts of Medicare as some are set to expire while others have been extended (see Medicare Compliance & Reimbursement, Vol. 49, No. 4).

Resources: Check out the Medicare Claims Processing Manual specifics at www.cms.gov/Regulations-and-Guidance/ Guidance/Manuals/Downloads/clm104c38.pdf, the COVID-19 FAQs at www.cms.gov/files/document/03092020-covid- 19-faqs-508.pdf, and CMS’ oft-updated COVID waiver links at www.cms.gov/coronavirus-waivers.