Codes for COVID-19 Professional Claims

Condition Codes and Modifier

The following Condition Codes and Modifier are available for use on the paper 1500 Claim Form and in the electronic 837 Professional:

• Condition Code DR - Disaster related (effective March 24, 2020)
• Modifier CR - Catastrophe/disaster related (effective March 24, 2020)
• Condition Code 90 - Service provided as part of an Expanded Access (EA) approval (effective January 19, 2021)
• Condition Code 91 - Service provided as part of an Emergency Use Authorization (EUA) (effective January 19, 2021)

The Centers for Medicare & Medicaid Services' (CMS) MLN Matters SE20011 provides more information on the use of Condition Code DR and Modifier CR for COVID-19 related Medicare claims. For Medicare, Condition Code DR is reported only in the institutional claim (electronic 837I or paper UB-04). The NUCC has approved the use of Condition Code DR in the professional claim due to the business need by other payers to identify COVID-19 related claims. Separately, CMS MLN Matters MM12049 provides additional information on the use of Condition Codes 90 and 91.

The complete list of Condition Codes available for use in the professional claim is available on the Condition Codes page under the Code Sets tab.

Provider Characteristics Codes

The NUCC has released the following new Health Care Provider Characteristics codes related to COVID-19:

• 6J - This provider offers testing for COVID-19 (effective April 1, 2020)
• 6K - This provider offers a vaccine for COVID-19 (effective January 1, 2021)

The complete list of Provider Characteristics codes is available under the Code Set tab.