In 2005, CMS created modifier “CR” (Catastrophic / 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 services affected as a result of future emergencies.
The use of modifier CR is an acknowledgement that the claim is affected by an emergency or disaster. It is used for Part B services for both institutional and noninstitutional billing. 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 because 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 is used for Part B items and services only, can be used for both institutional or non-institutional 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
- Telephone calls (98966‒98968; 99441‒99443) Note: These are not telehealth services
- 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 determines that such use is needed to efficiently and effectively process claims or to otherwise administer the Medicare fee-for-service program
CMS does not require modifier CR on telehealth services.
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
SE20011 Revised: Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)