tci Medicare Compliance & Reimbursement - 2020 Issue Q2

Reader Question: Get the COVID-19 Facts on CR Modifier and DR Condition Code Usage

Question: Are Medicare providers supposed to be using the CR modifier or DR condition code on COVID-19-related claims? SuperCoder Subscriber Answer: Yes, according to Centers for Medicare & Medicaid Services (CMS) guidance in the agency’s “COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing” brief. “With the exception of telehealth services, use of the ‘DR’ condition code and ‘CR’ modifier are mandatory for institutional and non-institutional providers in billing situations related to COVID-19 for any claim for which Medicare payment is conditioned on the presence of a ‘formal waiver,’” CMS...

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