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CMS Clarifies Use of COVID-19 Modifier, Condition Code

The Centers for Medicare & Medicaid Services (CMS) updated guidance for providers and suppliers who bill Medicare fee-for-service (FFS) to clarify the use of the catastrophe/disaster-related “CR” modifier and disaster-related “DR” condition code.

To assess the impact of prior emergencies, CMS has required the use of modifier “CR” and condition code “DR” for all services provided in a facility operating pursuant to CMS waivers that typically were in place, for limited geographical locations and durations of time.

During the COVID-19 public health emergency, CMS has issued blanket waivers and flexible options to increase hospital capacity, expand access to COVID-19 testing, promote telehealth, and augment the health care workforce. Due to the large volume and scope of these new blanket waivers and flexible options, CMS is clarifying which require the usage of modifier “CR” or condition code “DR” when submitting claims to Medicare.

Providers do not need to resubmit or adjust previously processed claims to conform to these requirements, unless payment of the claims was affected.

Visit the America’s Essential Hospitals coronavirus resource page for more information about the outbreak.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a principal policy analyst at America's Essential Hospitals.

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