Modifier CR as it Relates to Medicare Part B and COVID-19 Billing

In 2005, CMS created modifier “CR” (description: Catastrophe/disaster related) to assist MACs in processing claims as a result of Hurricane Katrina. This modifier was also authorized for use on Part B CMS-1500 claim forms for any services affected as a result of future emergencies.

The use of modifier CR is an acknowledgement that the claim (meaning service or item) is affected by an emergency or disaster. It is used in relation to Part B items and services for both institutional and noninstitutional billing. Noninstitutional billing, (i.e., claims submitted by physicians and other suppliers), are submitted either on a professional paper claim form, CMS-1500 or in the electronic equivalent.

Use of modifier CR is mandatory, with the exception of telehealth claims, for applicable CPT/HCPCS codes for which Medicare Part B payment is conditioned on the presence of a “formal waiver.” Under section 1135 of the Social Security Act, the Secretary may temporarily “waive” or modify certain Medicare requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and time periods, and that providers who provide such services in good faith can be reimbursed and exempted from sanctions (absent any determination of fraud or abuse).

Proper use of modifier CR:

• • Modifier CR may be used untill 5/11/2023
  • Modifier CR is used for Part B items and services only, but may be used in either institutional or noninstitutional billing
  • Use of modifier CR is required when an item or service is impacted by an emergency or disaster and Medicare payment for that item or service is conditioned on the presence of a “formal waiver”;
  • Some examples of claim types affected by the waiver on which you would add modifier CR:
    • Claims for testing services at newly set-up swab sites
    • Providers rendering services in states in which they are not licensed
    • Ambulance claims with newly approved destination modifiers
    • Services by a teaching physician supervised virtually under the waiver for an in-person supervision
  • Use of modifier CR may also be required when either the contractor or CMS determine that such use is needed to efficiently and effectively process claims or to otherwise administer the Medicare fee-for-service program
  • CMS is not requiring modifier CR on telehealth services

Related Content

• • Change Request 6451: The Use of the CR Modifier and DR Condition Code on Disaster/Emergency-Related Claims
  • CMS Internet-Only Manual Publication 100-04, Medicare Claims Processing Manual, Chapter 38, Section 20.1
  • MLN Matters ® SE20011 Revised: Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)
  • Interim Final Rule

Revised 4/10/2023