CMS clarifies use of catastrophe-related modifier and condition code

Wednesday, June 10, 2020

CMS released new guidance and clarification on the use of modifier -CR (catastrophe/disaster related) and condition code DR (disaster related) on June 1. The updated information was published in a revision version of MLN Matters Special Edition Article SE20011.

During previous emergencies, CMS released a limited number of waivers applicable to limited geographic areas. However, the agency has issued a large number of waivers that are applicable nationwide in response to the novel coronavirus (COVID-19) public health emergency. As a result, some organizations have struggled to determine which claims require modifier -CR, condition code DR, or both.

To help organizations navigate the waivers and applicable modifier and condition code, the revised SE20011 includes a chart that lists all waivers released to date. The right columns of the chart indicate whether modifier -CR or condition code DR apply.

For example, CMS waived the requirement that critical access hospitals (CAH) limit the number of inpatient beds to 25 and the average length of the stay to 96 hours. A CAH that is providing services under this waiver should use condition code DR but not modifier -CR.

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Billing and Claims, News, Revenue Integrity

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