Article - CY 2020: Common DME Modifiers

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.


Published By - Medical Billers and Coders
Published Date - Aug-27-2020 Back

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