Medicare Claims During Public Health Emergencies

If the President declares a disaster or emergency in an affected state, the Department of Health and Human Services (HHS) Secretary may, under Section 319 of the Public Health Service Act, declare a Public Health Emergency (PHE) and authorize waivers and flexibilities under Section 1135 of the Social Security Act (the Act). 

Blanket Waivers                                     

Sections 1135 or 1812(f)  of the Act allows CMS to issue blanket waivers to prevent gaps in access to care for patients affected by the disaster or emergency.

You don’t need to apply for an individual waiver if we issue a blanket waiver. If there’s no blanket waiver, you can apply for an 1135 waiver or submit a PHE-related inquiry:

• Get a quick-start guide to learn how to submit an 1135 waiver (PDF) or a PHE inquiry (PDF) (PDF)   
• Watch our YouTube training videos: 
  • 1135 Waiver/Flexibility Requests 
  • PHE-related Inquiry Requests 

How to Submit Claims

Use the following condition code and modifier for claims when Medicare payment is based on a formal waiver:

•  DR (disaster related) condition code for institutional billing 
  
  Example: Claims submitted using the ASC X12 837 institutional claims format or paper Form CMS-1450
• CR (catastrophe/disaster related) modifier for Part B billing, both institutional and non-institutional
  
  Example: Claims submitted using the ASC X12 837 professional claim format or paper Form CMS-1500 or, for pharmacies, in the NCPDP format                                   

For more information, find your MAC’s website.

Resources

• FAQs without Section 1135 (PDF) or other formal waiver
• FAQs with a Section 1135 (PDF) waiver or, when applicable, a Section 1812(f) waiver
• Survey & Certification FAQs (PDF)
• Current non-COVID emergencies
• DMEPOS (PDF) fact sheet for additional information and help during an emergency or disaster
• CMS Emergency Preparedness & Response Operations webpage