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

• CMS Change Request (CR) 6451 - The Use of the CR Modifier and DR Condition Code on Disaster/Emergency-Related Claims
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 38, Section 10