This message concerns the use of the “DR” condition code and the “CR” modifier on Medicare fee-for-service claims.

Raúl Alicea-Morales, MBA/HCM, CHA - Health Insurance Specialist - Puerto Rico Field Office - P:787-771-3660 - F:212-266-0536 - C:787-300-0389

A new informational website about the flu, both seasonal and H1N1, visit www.flu.gov  

www.StopMedicareFraud.gov

 

From: 18 existing FFS provider listservs [mailto:[e-mail]] On Behalf Of CMS CMSProviderResource
Sent: Friday, January 29, 2010 3:41 PM
To: [e-mail]
Subject: An Additional Friday Item Regarding the Use of the "DR" Condition Code and the "CR" Modifier on Medicare FFS Claims

 This message concerns the use of the “DR” condition code and the “CR” modifier on Medicare fee-for-service claims.

 As part of its response to the 2005 Katrina hurricane emergency, the Centers for Medicare & Medicaid Services (CMS) developed the “DR” condition code and the “CR” modifier to facilitate the processing of claims affected by that emergency. (See Transmittal 184 (CR 4106), issued on October 15, 2005.)  Use of these indicators was also authorized for claims affected by subsequent emergencies.  The discretionary use of these indicators by a provider or supplier was permitted and such use signified not only that the item or service was affected by an emergency or disaster, but also that the provider or supplier had met all of CMS’ requirements related to the furnishing of such item or services during the emergency or disaster.

 

Subsequently, on July 31, 2009, CMS issued Transmittal 1784 (CR 6451) which, among other things, narrowed the scope of permitted uses of these indicators.  In particular, it eliminated the discretionary use of both the “DR” condition code and the “CR” modifier by providers and suppliers.

 

For the H1N1 pandemic emergency, CMS has authorized the use of the “DR” condition code and the “CR” modifier only by providers that have been granted a formal waiver under § 1135 of the Social Security Act and then only for services affected by the emergency and while the waiver remains in effect.  No other provider or supplier may use either indicator at this time.

 

Providers and suppliers who have been annotating their claims with one or both indictors should cease doing so (unless they are operating under a formal 1135 waiver).  Processing of claims annotated with these indicators, that are submitted by providers and suppliers that have not been granted an 1135 waiver, may be delayed.

 

Please contact your local CMS Regional Office if you have questions or need more information.  You may also visit the H1N1 Web page at www.cms.hhs.govH1N1.

 

  It’s Not Too Late to Get the Seasonal Flu Shot.  While seasonal influenza outbreaks can happen as early as October, influenza activity usually peaks in January.[1] The seasonal flu vaccine is the best way to prevent infection and the complications associated with the flu.  Re-vaccination is necessary each flu season because flu viruses change each year. 

 

CMS is asking our health care provider community to please encourage your Medicare patients who haven’t already done so to get their annual flu shot.  It is also important to be sure that you immunize yourself and your staff. 

 

Remember - Influenza vaccine plus its administration are covered Part B benefits.  Note that influenza vaccine is NOT a Part D covered drug.

 

For information about Medicare’s coverage of the seasonal influenza virus vaccine and its administration, as well as related educational resources for health care professionals and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website.  You will find a variety of resources that explain Medicare coverage and claims submission policies related to the seasonal influenza vaccine.

For information on Medicare policies related to H1N1 influenza, please go to http://www.cms.hhs.gov/H1N1 on the CMS website.

 

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 [1] Seasonal Influenza, 2009-2010. Key Facts About Seasonal Flu Vaccine [online]. Atlanta, GA: The Centers for Disease Control and Prevention, 2009 [cited 23 December 2009]. Available from the World Wide Web:
(http://www.cdc.gov/flu/protect/keyfacts.htm)