Use of CR modifier and "COVID-19" narrative on Specified Claims Due to the COVID-19 PHE

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 instructed 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. 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 our websites, our Interactive Voice Response (IVR) System, and upcoming joint webinars by our Provider Outreach and Education (POE) departments.

Publication History

Date of Change Description
May 28, 2020 Originally Published

 

Last Updated Fri, 29 May 2020 13:09:26 +0000