Hi Bill.
I asked one of my colleagues to chime in on your question. Her response if from part of a free web-cast that we did last week. I know there were quite a few of the names that I normally see on this forum that I see that attended, but in these strange times, I think more information on a rapidly changing topic cannot hurt. To that end, in addition to answering your specific question, I am including the link to the webcast. Please take advantage of this as you see fit.
I hope everyone is healthy and stays well
Jeff
Here is the answer from my colleague, Kathy Pride (she was the 1st of 4 speakers we had on the webcast):
- Can you please explain the use of modifier CR and how it differs from the CS modifier?
CR Modifier - 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. 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."
Proper use of modifier CR:
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
- 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 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 (use modifier 95 for telehealth services)
CS Modifier is used to identify COVID-19 related E&M services that are subject to the cost-sharing waiver (waiver of copay and deductibles). The guidance from the MLN Connects special edition dated April 7, 2020states "COVID-19 testing-related services billed to Medicare Part B" applies to "medical visits that are furnished between March 18, 2020 and the end of the PHE, that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test; and are in any of the following categories of HCPCS evaluation and management codes:
- Office and other outpatient services
- Hospital observation services
- Emergency department services
- Nursing facility services
- Domiciliary, rest home, or custodial care services
- Home services
- Online digital evaluation and management services"
Here is the link:
Please register for ON-DEMAND: COVID-19 PHE Changes in Documentation, Coding and Billing Update on Apr 21, 2020 2:52 PM EDT at:
https://attendee.gotowebinar.com/register/4651626184705104911
After registering, you will receive a confirmation email containing information about joining the webinar.
Brought to you by GoToWebinar®
Webinars Made Easy®
Jeff Majchrzak, BA, CIRCC, RCC
Vice President, Radiology and Cardiology Consulting Services
T 651-424-4206
C 651-308-5011
www.panaceainc.com
Subscribe to Panacea Insights
Stay up to date on the latest in healthcare coding,
compliance, and reimbursement
*HFMA staff and volunteers determined that CDMauditor® – Hospital Zero-Base Pricing® and related modules have met certain criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this service.