Modifier CR

Catastrophe/Disaster

Correct Use

This modifier must be submitted only when an item or service is impacted by an emergency or disaster.

  • Use for both institutional and non-institutional billing
  • Effective August 31, 2009: use of CR modifier is mandatory for applicable HCPCS codes on any claim for which Medicare Part B payment is conditioned directly or indirectly on the presence of a "formal waiver"
  • Formal Waiver: waiver of a program requirement that otherwise would apply by statute or regulation
    • Two types of formal waivers
      • Waiver of a requirement specified in Section 1135(b) of the Social Security Act. This may permit Medicare payment in a circumstance where payment would otherwise be barred.
      • Waiver based on a provision of the Title XVIII of the Act or its implementing regulations.

In the event of a disaster or emergency, CMS will issue specific guidance to Medicare contractors.

Incorrect Use

  • When there are no instructions from CMS to use the modifier
  • Item/service/claim was not affected by an emergency/disaster

Resources

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