Replacement Equipment for Beneficiaries Affected by Hurricanes
Medicare will pay for the replacement of equipment which the beneficiary owns or is purchasing, is oxygen equipment, or is a capped rental item – when the equipment/item is lost, destroyed, irreparably damaged, or otherwise rendered unusable due to circumstances relating to an emergency declared by the President. This includes inexpensive or routinely purchased items, customized items, and other prosthetic and orthotic devices.
In accordance with CR6451, use of the "CR" modifier is mandatory on claims for items and services for which Medicare payment is conditioned on the presence of a "formal waiver" including, but not necessarily limited to, waivers granted under either Section 1135 or Section 1812(f) of the Act.
The "RA" modifier is also required on the claim for a replacement base item. If the beneficiary is displaced from the Federally-declared disaster/emergency area, the beneficiary may obtain the replacement item from a Medicare-enrolled supplier located outside such area.
If the supplier is aware that the item is a replacement, the supplier should annotate the claim with the RA modifier in addition to CR modifier and any other applicable modifiers.
When items that usually require prior authorization are replaced due to a disaster under a waiver prior authorization will not be required. Follow the above billing information.
Suppliers must include a narrative on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable as a result of the hurricane.
Resources
Medicare Claims Processing Manual, Chapter 20, Section 50
, regarding Medicare's customary payment policy for replacement of DMEPOS. This policy is also applicable in an emergency.
Additional information is also located at: Emergency-Related Policies and Procedures That May Be Implemented Without § 1135 Waivers and Additional Emergency and Disaster-Related Policies and Procedures That May Be Implemented Only With a § 1135 Waiver. Refer to Section I for DME replacement related questions.
Revised: 10.07.24
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