Has CMS released any information to clarify when we should be using condition code DR or modifier CR?
On June 1, 2020 CMS released a revised Special Edition Bulletin, SE20011, to provide greater clarity on the appropriate use of both condition code DR and modifier CR. Within the revised article, CMS has added a table that lists which waivers require the use of condition code DR or modifier CR. In the article CMS states that failure to append either condition code DR or modifier CR to claims affected by the waivers noted in the table may result in claim denial.
Per CMS, only those waivers noted in the table require the use of condition code DR or modifier CR, although CMS states claims will not be denied if the condition code or modifier are appended to services unrelated to the waivers listed.
CMS states providers are not required to resubmit or adjust any previously submitted claims to conform with the updated guidelines unless claim payment was affected.
CMS SE20011 “Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)”:
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