CR - JE Part B
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.
- Two types of formal waivers
In the event of a disaster or emergency, CMS will issue specific guidance to Medicare contractors.
- When there are no instructions from CMS to use the modifier
- Item/service/claim was not affected by an emergency/disaster
- CMS Medicare Learning Network (MLN) Matters MM6451-Revised
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 38, Section 10
Last Updated Tue, 31 Dec 2019 12:28:34 +0000