RETIRED - Use of CR Modifier and "COVID-19" Narrative on Specified Claims Due to the COVID-19 PHE - Revised

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.

Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Joint DME MAC Bulletin Article

On May 21, 2020, the DME MAC medical directors revised a joint bulletin article titled, "CMS Issues Interim Final Rules with Comment (CMS-1744-IFC & CMS-5531-IFC) – COVID-19 Public Health Emergency." The bulletin article instructs suppliers to append the CR modifier and "COVID-19" narrative to claims for dates of service on or after March 1, 2020, where the coverage, coding, or documentation requirements are impacted by the COVID-19 Public Health Emergency (PHE). This includes use of the CR modifier and "COVID-19" narrative for the duration of the COVID-19 PHE, when billing for items and/or services included in the local coverage determinations (LCDs) and national coverage determinations (NCDs) listed in CMS-1744-IFC and CMS-5531-IFC.

A recent data analysis indicates that some suppliers are not following these instructions, leading to claim denials. In order to expedite a resolution, the DME MACs recommend suppliers resubmit these claims with the addition of the CR modifier and "COVID-19" narrative as long as the claims were not denied as not medically necessary. If the initial claim was denied as not medically necessary due to missing the CR modifier and "COVID-19" narrative, the claim must be sent to a written reopening for correction.

Claim instructions in our prior bulletin article are noted below.

Claim Instructions:
Suppliers should continue to use the appropriate modifiers, including the KX modifier where applicable, for all HCPCS codes included in the NCDs and LCDs listed above. In addition, the CR modifier (CATASTROPHE/DISASTER RELATED) should be added to the HCPCS code(s) billed. Finally, suppliers are instructed to enter "COVID-19" in the NTE 2400 (line note) or NTE 2300 (claim note) segments of the American National Standard Institute (ANSI X12) format or field 390-BM of the National Council for Prescription Drug Program (NCPDP) format. These abbreviations may also be used in Item 19 of the CMS-1500 claim form.

Additional information can be found on the COVID-19 section of our websites.

Publication History

Date of Change Description
05/28/20 Originally Published
05/06/21 Revised for not medically necessary denials
05/12/23 Retired

 

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