Tuesday, June 8, 2010

Disaster related Modifier

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


In order to facilitate claims processing and track services and items provided to beneficiaries during disaster/emergency situations, a modifier and condition code have been established for providers to use on disaster/emergency related claims. The modifier and condition code have been in effect since August 21, 2005. The codes are effective for dates of service on and after August 21, 2005. The modifier and/or condition code can be used by providers submitting claims for beneficiaries who are emergency patients in any part of the country.

The DR Condition Code:
The title of the DR condition code is “disaster related” and its definition requires it to be “used to identify claims that are or may be impacted by specific payer/health plan policies related to a national or regional disaster.” The DR condition code is used only for institutional billing, i.e., claims submitted by providers on an institutional paper claim form CMS-1450/UB-04 or in the electronic format ANSI ASC X12 837I. In previous emergencies, use of the DR condition code has been discretionary with the billing provider or supplier. It no longer may be used at the provider or supplier’s discretion. Use of the DR condition code will be mandatory for any claim for which Medicare payment is conditioned on the presence of a “formal waiver,”as defined below. The DR condition code also may be required for any type of claim for which, at the Medicare claims processing contractor’s discretion or as directed by CMS in a particular disaster or emergency, the use of the DR condition codeis needed to efficiently and effectively process claims or to otherwise administer the Medicare fee-for-service program.

The CR Modifier: Both the short and long descriptors of the CR modifier are “catastrophe/disaster related.” The CR modifier is used in relation to Part B items and services for both institutional and non-institutional billing. Non-institutional billing, i.e., claims submitted by “physicians and other suppliers”, are submitted either on a professional paper claim form CMS-1500 or in the electronic format ANSI ASC X12 837P or – for pharmacies – in the NCPDP format. In previous emergencies, use of the CR modifier has been discretionary with the billing provider or supplier. It no longer may be used at the provider or supplier’s discretion. Use of the CR modifier will be mandatory for applicable HCPCS codes on any claim for which Medicare Part B payment is conditioned on the presence of a “formal waiver,” as defined below. The CR modifier also may be required for any HCPCS code for which, at the Medicare claims processing contractor’s discretion or as directed by CMS in a particular disaster or emergency, the use of the CR modifier is needed to efficiently and effectively process claims or to otherwise administer the Medicare fee-for-service program.

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