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CMS Clarifies Use of New Condition Codes 90 and 91

Analysis  |  By Revenue Cycle Advisor  
   November 30, 2020

The National Uniform Billing Committee (NUBC) recently created the condition codes for use on healthcare claims, effective February 1, 2021.

A version of this article was first published November 30, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

CMS on November 20 released MLN Matters 12049, which clarifies the effective date and appropriate use of two new National Uniform Billing Committee (NUBC) condition codes.

NUBC recently created the following condition codes for use on healthcare claims:

  • 90, service provided as part of an Expanded Access (EA) approval
  • 91, service provided as part of an Emergency Use Authorization (EUA)

Both condition codes have an effective date of February 1, 2021, according to CMS.

Condition code 90 should be reported to claims with EA services.

The EA program, sometimes referred to as the compassionate use program, allows patients to receive investigational drugs or medical devices outside of an established clinical trial when there are no adequate and available treatment alternatives.

Condition code 91 should be reported on claims when patients receive medical services granted an EUA by the FDA.

An EUA allows patients to receive treatments that have not yet been granted full FDA approval during a public health emergency when there are no adequate and available treatment alternatives. 

Several therapies have been granted an EUA for the treatment of COVID-19 including convalescent plasma, remdesivir, and bamlanivimab.

Revenue Cycle Advisor combines all of HCPro's Medicare regulatory and reimbursement resources into one handy and easy-to-access portal. News is not just repeated from other sources. It is analyzed by our Medicare experts so professionals can comprehend any new rule and regulatory updates thoroughly. Learn more.

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