Saturday, May 29, 2010

Disaster/Emergency-Related CR and ER modifiers

Use of the CR Modifier and DR Condition Code for Disaster/Emergency-Related Claims

Policy:

The DR Condition Code:
• The DR condition code is used for institutional billing only.
• Use of the DR condition code is required when a service is affected by an emergency or disaster and Medicare payment for such service is conditioned on the presence of a “formal waiver” (as that term is described in “Background”, above)
•Use of the DR condition code also may be required when either the contractor or CMS determine that such use is needed to efficiently and effectively process claims or to otherwise administer the Medicare fee-for-service program.
• The DR condition code is used at the claim level when all of the services/items billed on the claim are related to the emergency/disaster.


The CR Modifier:
• The CR modifier is used for Part B items and services only but may be used in either institutional or non-institutional billing.
• Use of the CR modifier is required when an item or service is impacted by an emergency or disaster and Medicare payment for such item or service is conditioned on the presence of a “formal waiver” (as that term is described in “Background”, above)
• Use of the CR modifier also may be required when either the contractor or CMS determine that such use is needed to efficiently and effectively process claims or to otherwise administer the Medicare fee-for-service program.

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