Monday, June 1, 2020

CMS Updates Guidance on Proper Use of COVID-19 Waivers Claim Codes

Dan Ciolek 

On June 1 CMS issued updated guidance clarifications for using the “DR” Condition Code and “CR” modifier on Medicare fee-for-service claims for services furnished under COVID-19 Section 1135 waivers such as the SNF-specific 3-day stay and spell-of-illness waivers. The full list of waivers and flexibilities can be found here.

CMS is clarifying which waivers the usage of modifier “CR” or condition code “DR” when submitting claims to Medicare. The chart in the updated guidance identifies those blanket waivers and flexibilities for which CMS requires the use of the modifier or condition code.

Please note that CMS will not deny claims due to the presence of the “CR” modifier or “DR” condition code for services/items related to a COVID-19 waiver that are not on this list, or for services/items that are not related to a COVID-19 waiver. There may be potential claims implications, such as claims denials, for claims that do not contain the modifier or condition code as required in the chart. However, providers do not need to resubmit or adjust previously processed claims to conform to the requirements below, unless claims payment was affected.

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