CR Modifier & DR Condition Code Tags: Disaster Claims

This Transmittal updates and amends claims processing requirements for the use of condition codes and modifiers on Medicare fee-for-service claims when the furnishing of an item or service to a Medicare beneficiary was affected by a disaster or other general public emergency. As part of its response to the 2005 Katrina hurricane emergency,

CMS developed the “DR” condition code tag and the “CR” modifier to facilitate the processing of claims affected by that emergency.

The DR Condition Code

• The DR condition code is used for institutional billing only.
• Use of the DR condition code is required effective August 31, 2009 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”.
• 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 tag 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 effective August 31, 2009 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”.
• 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.

A “formal waiver” is a waiver of a program requirement that otherwise would apply by statute or regulation.

In the event of a disaster or emergency, CMS will issue specific guidance to Medicare contractors that will contain a summary of the Secretary’s declaration (if any); specify the geographic areas affected by any declarations of a disaster or emergency; specify what formal waivers and/or informal waivers, if any, have been authorized; specify the beginning and end dates that apply to the use of the DR condition code and/or the CR modifier; and specify what other uses of the condition code and/or modifier, if any, will be mandatory for the particular disaster/emergency.