Post COVID-19 Public Health Emergency (PHE)

Public Health Emergency (PHE) for COVID-19 Ended May 11, 2023

On February 9, 2023 the Department of Health and Human Services (HHS) announced the Public Health Emergency (PHE) for COVID-19 will end on May 11, 2023. The CR modifier should only be reported during a PHE when a formal waiver is in place. Suppliers have been directed to discontinue using the CR modifier and COVID-19 narrative for claims with initial dates of service on or after May 12, 2023.

Post-PHE Continued Usage of Modifier CR for Suppliers in Specific Circumstances

On or after May 12, 2023, suppliers are instructed to continue the use of the CR modifier and the COVID-19 narrative for any DMEPOS item (ongoing rentals) and related supplies/accessories where the base item was initially dispensed during the PHE or specifically excluded from the enforcement of clinical indications of coverage. The continued use of the CR modifier and COVID-19 narrative post-PHE is intended to allow the DME MACs to continue PHE system editing for PHE-dispensed DMEPOS items and provide the ability to identify these claims for future review, if indicated. Refer to the Medical Director article: Claim Submission Instruction Post-PHE-Continued Use of Modifier CR and COVID Narrative.

Affected Policies

National Coverage Determinations (NCDs)

  • Continuous Positive Airway Pressure for Obstructive Sleep Apnea (NCD 240.4)
  • Durable Medical Equipment Reference List (NCD 280.1) - Only clinical indications for ventilators were not enforced
  • Home Oxygen (NCD 240.2)
  • Infusion Pumps (NCD 280.14)
  • Intrapulmonary Percussive Ventilator (NCD 240.5)

Local Coverage Determinations (LCDs)

  • External Infusion Pumps (L33794)
  • Glucose Monitors (L33822) - Only clinical indications for Continuous Glucose Monitors (CGM) were not enforced
  • High Frequency Chest Wall Oscillation (L33785)
  • Mechanical In-exsufflation Devices (L33795)
  • Nebulizers (L33370)
  • Oral Appliances for the Treatment of Obstructive Sleep Apnea (L33611)
  • Oxygen and Oxygen Equipment (L33797)
  • Positive Airway Pressure Devices for the Treatment of Obstructive Sleep Apnea (L33718)
  • Respiratory Assist Devices (L33800)
  • Suction Pumps (L33612) - Only clinical indications for respiratory suction pumps (E0600) were not enforced

Waivers ended include the following for initial dates of service on or after May 12, 2023:

  • Certain face-to-face/in-person encounters
  • Clinical indications for coverage found in respiratory, infusion pump, and continuous glucose monitor National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs)
  • Proof of delivery
  • Part B drugs providing more than a 30-day supply

Telehealth

  • During the PHE, individuals with Medicare had broad access to telehealth services, including in their homes, without the geographic or location limits that usually apply
  • Telehealth services provided through telecommunications systems (for example, computers and phones) allows health care providers to give care to patients remotely in place of an in-person office visit
  • Suppliers are encouraged to confirm that the treating practitioner has provided and is billing a valid telehealth visit for the item(s) they have ordered. No specific type of verification is recommended or required. This protects suppliers in case of review and ensures beneficiaries receive the correct DMEPOS for their condition. A telehealth visit may be verified by a reviewing entity for correct DMEPOS payment consideration. You can find the list of valid telehealth requirements by CPT code on the CMS.gov List of Telehealth Services webpage.

Clinical Indications

  • For initial dates of service on and after May 12, 2023, clinical indications of coverage have been reinstated
  • Clinical indications for coverage found in respiratory, infusion pump, and continuous glucose monitor NCDs or LCDs will be enforced
  • For the coverage criteria, refer to the policy specific LCDs and Policy Articles

Affected Policies

  • External Infusion Pumps (L33794)
  • Glucose Monitors (L33822) - Only clinical indications for Continuous Glucose Monitors (CGM) were not enforced
  • High Frequency Chest Wall Oscillation (L33785)
  • Intrapulmonary Percussive Ventilator (NCD 240.5)
  • Mechanical In-exsufflation Devices (L33795)
  • Nebulizers (L33370)
  • Oral Appliances for the Treatment of Obstructive Sleep Apnea (L33611)
  • Oxygen and Oxygen Equipment (L33797)
  • Positive Airway Pressure Devices for the Treatment of Obstructive Sleep Apnea (L33718)
  • Respiratory Assist Devices (L33800)

Proof of Delivery (POD) - Method I

(As found in the Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426) Local Coverage Article.)

  • Signature requirements are reinstated for dates of service on and after May 12, 2023
  • For items delivered during the PHE, there is no requirement to obtain a new POD

Part B Drugs

  • For dates of service on and after May 12, 2023, DME MACs will no longer make payment for greater than 30-day supply for the following drugs:
    • Immunosuppressive, oral anticancer, intravenous immune globulin (IVIG), and enteral nutrition

Appeals

 

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