Condition Code DR for Medicaid Institutional Claims

May 29, 2020

The Illinois Department of Healthcare and Family Services (HFS) recently posted a Provider Notice to instruct providers to use Condition Code DR (Disaster Related) to track claims associated with COVID-19 treatment. Condition Code DR must be present for service dates beginning January 27, 2020, on a claim that includes one of the following diagnostic codes:

  • B97.29 - Other coronavirus as the cause of diseases classified elsewhere (for services provided prior to April 1, 2020);
  • U07.1 - COVID-19 (for services provided on or after April 1, 2020);
  • Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out; Z11.59 Encounter for screening for other viral diseases; and
  • Z20.828 - Contact with and suspected exposure to other viral communicable diseases.

These instructions apply to Medicaid fee-for-service (FFS), Managed Medicaid (HealthChoice Illinois), and Medicare/Medicaid Alignment Initiative (MMAI) plans.