When billing for durable medical equipment (DME), use the appropriate HCPCS code and modifier(s) to describe the items being billed. Also include an ICD-9/ICD-10 diagnosis code indicating the medical condition for which the item has been prescribed.
In addition to an appropriate HCPCS code for the DME item, many HCPCS codes require a modifier. The modifiers are used to provide more information about the item. For example, the modifier may tell HMSA that an item is new, used, or rented on a capped basis. For capped rentals, modifiers distinguish which month's rental is being billed.
If these modifiers are used incorrectly or missing, the claim may be denied. To expedite processing of your claims, please indicate first-month rental by including the appropriate modifier code, and bill your claims in sequential order.
Common modifiers
• RR - Rental
• NU - Purchase of new equipment
• UE - Purchase of used equipment
Modifiers RR, NU, and UE should be used for the following categories:
• Inexpensive or Routinely Purchased (IRP) Item
• Capped Rental item
• Items Requiring Frequent and Substantial Servicing
• Oxygen Equipment (not contents)
For capped rentals, use RR and one of these additional modifiers to indicate rental period:
• KH – Initial claim, first-month rental
• KI – Second and third capped rental months
• KJ – Fourth to 13th capped rental months
Maintenance and Servicing
MS – Six-month maintenance and servicing fee for reasonable and necessary parts and labor that are not covered under any manufacturer or supplier warranty. This is covered for capped rental items prior to Jan. 1, 2006. Payment is not made for maintenance and servicing of capped rental items in which the first month occurs on or after Jan. 1, 2006. Maintenance and services payments will be made for oxygen equipment every six months, starting six months after the member first owns the equipment.
Replacement and Repair
• RA – Replacement of a DME item due to loss, irreparable damage, or theft. This is used on the first-month rental claim for a replacement item.
• RB – Replacement of a part of DME as part of a repair
KX Modifier – Documentation on File
KX – The KX modifier should be added to the code to indicate that specific required documentation is on file to support the medical necessity of the item. The following policies address KX modifier usage:
• Automatic External Defibrillators
• Cervical Traction Devices
• Commodes
• Continuous Positive Airway Pressure System
• Epoetin
• External Infusion Pumps
• Glucose Monitors
• High-Frequency Chest Wall Oscillation Devices
• Home Dialysis Supplies and Equipment
• Hospital Beds and Accessories
• Manual Wheelchair Base
• Nebulizers
• Negative Pressure Wound Therapy Pumps
• Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
• Orthopedic Footwear
• Power Mobility Devices
• Pressure Reducing Support Surfaces
• Refractive Lenses
• Respiratory Assist Devices
• Speech Generating Devices
• Therapeutic Shoes for Persons with Diabetes
• Transcutaneous Electrical Nerve Stimulators
• Urological Supplies
• Walkers
• Wheelchair Options/Accessories
• Wheelchair Seating
Right and Left Modifiers
The RT and LT modifiers are used in reference to many different policies. Consult these policies for the proper use of the RT and LT modifiers:
• Ankle-Foot/Knee-Ankle-Foot Orthosis
• External Breast Prosthesis
• Eye Prosthesis
• Facial Prosthesis
• Lower Limb Prosthesis
• Orthopedic Footwear
• Refractive Lenses
• Surgical Dressings
• Therapeutic Shoes for Persons with Diabetes
• Wheelchair Option/Accessories
99 Modifier overflows
• The KB modifier only applies to beneficiary upgraded claims for DMEPOS where the supplier obtained an ABN and there are more than four modifiers on the claim line. The 99 modifier is used in any other situation when a claim line has more than four modifiers.
• When a supplier uses more than four modifiers, the KB or 99 must be added as the fourth modifier to the HCPCS code. On paper claims, the remainder of the modifiers must be listed in Item 19 with an indicator as to which line they apply to. On electronic claims, the remainder should be entered in the NTE segment, the 2400 loop.
• These are not all-inclusive lists. For additional information on modifiers, see the Supplier Manual in the News and Publications section of our website. A complete listing of modifiers is available in Chapter 16, Coding. Also, remember to verify modifier usage in the policies.
