That is great news for DME suppliers … but it is not air tight.
Next Episode: Thursday, September 21, 2023
Current CR Modifier Instructions do not Apply to all Equipment
The DME MAC guidance is a win for suppliers, but it is not as comprehensive as it may at first appear. It reads in part:
“The CR Modifier and COVID-19 narrative can continue to be used for any DMEPOS item (ongoing rentals) and related supplies and accessories where the base item was initially dispensed, rendered, or otherwise impacted by the PHE (dates of service on March 1, 2020 through May 11, 2023) and specifically excluded from enforcement of the clinical indications of coverage referenced in Interim Final Rules CMS-1744-IFC and CMS-5531-IFC [emphasis added].”
In my opinion, the bolded clause unnecessarily limits the scope of the continued use of the CR modifier. The cited rules include clinical indication waivers only for the following:
- Respiratory products.
- Continuous glucose monitors.
- Infusion pumps.
Unfortunately, the guidance does not apply to other important PHE waivers. For example, there were 12 other local coverage determinations (LCDs) subject to FTF waivers during the pandemic, including:
- Manual Wheelchair Bases.
- Power Mobility Devices.
- Wheelchair Options/Accessories.
- Wheelchair Seating.
- Negative Pressure Wound Therapy Pumps.
- Pressure Reducing Support Surfaces – Group 1.
- Pressure Reducing Support Surfaces – Group 2.
- Pressure Reducing Support Surfaces – Group 3.
- Tumor Treatment Field Therapy (TTFT).
- Urological Supplies.
- Speech Generating Devices (SGD).
- Knee orthoses.
Other scenarios for which there is no current basis for using the CR modifier after May 11, 2023, include:
- Proof of delivery waivers.
- Future replacements to equipment initialized during the PHE.
Medicare should permit continued use of the CR modifier for these products after the PHE, assuming they meet similar criteria included in the DME MAC bulletin. Suppliers should not do so, however, until the DME MACS specifically authorize the practice with additional instructions.
Next Steps
I remain optimistic the MACs will ultimately expand their guidance to address other PHE-related scenarios that affect rental and resupply claims, namely the FTF and proof of delivery waivers. And while less urgent, suppliers will also need guidance on billing replacement equipment where the original delivery was subject to either a clinical indication or a FTF waiver.
As it stands, the current guidance is narrow in its scope, but we think this is an excellent first step. We expect there will be at least one revision, if not more, as the MACs unravel the implications of this upcoming transition.