Know your DME Modifiers



Equipment that provides therapeutic benefits to a patient and is primarily for long term and home use is termed as Durable Medical Equipment (DME). Due to a wide variety of models for DME, Centers for Medicare and Medicaid Services (CMS) instituted the Healthcare Common Procedure Coding System (HCPCS) and modifiers which correspond to the parameters policy and LCD, and make the HCPCS code valid before claim processing.

Modifiers are divided into several categories:

Routinely purchased Pricing Modifiers:

NU Purchase of New DME
RR Rented DME
UE Purchase of Used DME
NR New when rented

Capped Rental Items and modifiers: One can use RR in this category except wheelchairs where the patient is allowed the option to buy one. Others are:

BR Receiver has elected to rent
BP Receiver has elected to purchase
BU Rent or purchase not selected past 30 days despite a notification
KH Purchase or First rental month
KI Second and third rental months
KJ Fourth to thirteenth rental months
KR Rental but partial month billing
LL Lease/Rental (Medicaid)

Other Categories:

MS Maintenance DME
MM Maintenance and Servicing
RP Replacement and repair
A1 to A9 Surgical Dressings
CG Spinal Orthosis

Modifiers for Oxygen and the Corresponding equipment:

RR Rental
QE Prescribed oxygen is less than 1 LPM
QF Prescribed oxygen exceeds 4 LPM and portable oxygen is prescribed
QG Prescribed oxygen is greater than 4 LPM
QH When an oxygen conserving device is used with an oxygen delivery system

Functional Modifiers for Prosthetics and Orthotics:

K0 to K4 Used for various categories in Lower Limb Prostheses
RA Replacement of DME, orthotic or prosthetic
QF Replacement of a part of the above

Osteogenesis Stimulators:

KF modifier (FDA Class III device) to be used with E0747, E0748 and E0760.

Tape (A4450, A4452):

AX Items in concurrence with dialysis services
AU Items in urological, ostomy or tracheostomy supply
AV Items with a prosthetic or orthotic device
AW Items in surgical dressing with billing codes for tape A4450 and A4452

Drug Formulations (

KO Single drug unit dose formulation
KP First drug of a multiple drug unit dose formulation
KQ Second or subsequent drug of a multiple drug unit dose formulation

Anatomic Modifiers:

RT (Right) and LT (Left) modifiers are used in cases such as refractive lenses, eye prosthesis, facial prosthesis, orthopedic footwear etc.
KM Replacement of facial prosthesis including new impression
KN Replacement of facial prosthesis using previous master model
KX Used in cases such as external infusion pumps, home dialysis supplies, nebulizers, hospital beds, walkers, cervical traction devices etc.
KS Patient is glucose monitor supplied, not insulin

Up gradation/Prescription requirement:

EY Used when a supplier does not have a doctor’s order.
GA When supplier has an ABN on file.
GZ Item denied as not reasonable.
GY When an item is not covered and does not have a Medicare benefit.
GK and GL modifiers are upgrades wherein GK is a necessary upgrade of the equipment whereas GL is not.

Added modifiers:

KB or 99 used in cases of 4 or more modifiers.
KL (delivered by mail), KV, KT, J4, KE, KG, KK, KU, KW, KY Refers to DMEPOS items and their bidding.

As mentioned above, DME modifiers are two-character alpha or numeric codes that are added to the end of a HCPCS codes to elucidate the benefits when billed. Adding these augments the reimbursement process.

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