Continued Use of Modifier CR and COVID-19 Claim Narrative

The DME MACs are issuing this information due to recent questions from suppliers.

National DME MAC Education

Continue using the CR modifier and COVID-19 narrative when billing for any DMEPOS item (ongoing rentals) and related supplies/accessories if:

  • Base item was initially provided during the Public Health Emergency (PHE) (dates of service on March 1, 2020 - May 11, 2023) and
  • Excluded from enforcement of clinical indications of coverage in Interim Final Rules CMS-1744-IFC and CMS-5531-IFC.

How to Submit Claims:

  • Add CR modifier and any other applicable modifiers
  • Add claim narrative: COVID-19
    • Electronic Claims: NTE 2400
    • Paper Claims (CMS-1500 Claim Form): Item 19

This helps Medicare continue processing and tracking claims for future review.

National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) affected by these rules are:

  • Home Oxygen (NCD 240.2)
  • Infusion Pumps (NCD 280.14)
  • Continuous Positive Airway Pressure for Obstructive Sleep Apnea (NCD 240.4)
  • Intrapulmonary Percussive Ventilator (NCD 240.5)
  • Durable Medical Equipment Reference List (NCD 280.1) - Only clinical indications for ventilators are not enforced
  • Oxygen and Oxygen Equipment (L33797)
  • Positive Airway Pressure Devices for the Treatment of Obstructive Sleep Apnea (L33718)
  • Oral Appliances for the Treatment of Obstructive Sleep Apnea (L33611)
  • Respiratory Assist Devices (L33800)
  • Mechanical In-exsufflation Devices (L33795)
  • High Frequency Chest Wall Oscillation (L33785)
  • Nebulizers (L33370)
  • Suction Pumps (L33612) - Only clinical indications for respiratory suction pumps (E0600) are not enforced
  • Glucose Monitors (L33822) - Only clinical indications for Continuous Glucose Monitors (CGM) are not enforced
  • External Infusion Pumps (L33794)

When an item initially provided under waiver is replaced due to the 5-year Reasonable Useful Lifetime (RUL), the beneficiary doesn’t need to requalify for the item. However, replacement rules must be followed, and suppliers should continue to use the CR modifier.

For example, if a PAP device is replaced after the 5-year RUL, the beneficiary must have an in-person evaluation by their treating practitioner that documents that the beneficiary continues to use and benefit from the PAP device. There is no requirement for a new sleep test or trial period.

Last Updated Apr 10 , 2025