Disaster or Emergency Situation Billing

To facilitate claims processing and track services and items provided to beneficiaries during disaster and emergency situations, a modifier and condition code have been established for providers to use on disaster and emergency-related claims.

The DR Condition Code 

The title of the DR condition code is “disaster related” and its definition requires it to be “used to identify claims that are or may be impacted by specific payer/health plan policies related to a national or regional disaster.” The DR condition code is used only for institutional billing.

The CR Modifier

The title of the CR modifier is “catastrophe/disaster related.” This modifier must be submitted only when an item or service is impacted by an emergency or disaster. The CR modifier is used by institutional and non-institutional billing. Use of CR modifier is mandatory for applicable HCPCS codes on any claim for which Medicare payment is conditioned directly or indirectly on the presence of a "formal waiver."

Formal Waiver

A formal waiver is a waiver of a program requirement that otherwise would apply by statute or regulation. There are two types of formal waivers:

1. Waiver of a requirement specified in Section 1135(b) of the Social Security Act. This may permit Medicare payment in a circumstance where payment would otherwise be barred.
2. Waiver based on a provision of the Title XVIII of the Act or its implementing regulations

In the event of a disaster or emergency, CMS will issue specific guidance to Medicare contractors.  

Incorrect Use of the DR or CR modifier

• When there are no instructions from CMS to use the modifier
• Item/service/claim was not affected by an emergency/disaster

When submitting a claim to Medicare, please ensure you include a verification statement and the disaster name in the Remarks field. The dates of service must be within the specified disaster period.

Resources

Please refer to the CMS IOM 100-4 Medicare Claims Processing Manual, Chapter 38, Section 10 – Use of the CR Modifier and DR Condition Code for Disaster/Emergency-Related Claims (PDF) and Medicare Claims During Public Health Emergencies.