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Equipment that provides therapeutic benefit to a patient and is primarily for long-term and home use is termed durable medical equipment (DME). Because DME spans so many item types and models, the Centers for Medicare & Medicaid Services (CMS) uses HCPCS Level II codes together with modifiers. Modifiers tell the DME MAC how an item was supplied and whether the coverage criteria in the applicable Local Coverage Determination (LCD) were met. This guide groups the DME modifiers suppliers use most, with updated descriptors for 2026.
Key Takeaways
- DME modifiers are two-character codes appended to HCPCS codes that describe how an item was supplied: new, used, rented, or replaced.
- Capped rental items follow a fixed sequence: KH (first month), KI (second and third months), and KJ (months four through fifteen).
- Oxygen claims need flow-rate modifiers (QE, QF, QG) and QH when an oxygen-conserving device is used.
- KX confirms that LCD criteria are met. GA, GZ and GY show ABN and coverage status, and missing or mismatched pairs are a leading cause of DMEPOS denials.
- RA and RB replaced the deleted RP modifier for replacements and repairs.
DME Modifiers by Category
Purchase and Rental Pricing Modifiers
| NU | New equipment (purchase of new DME) |
| UE | Used durable medical equipment (purchase of used DME) |
| RR | Rental (use with DME rental items) |
| NR | New when rented (item was new at the time of rental and later purchased) |
Capped Rental Items and Modifiers
Capped rental items are paid on a monthly rental basis, and RR applies to every rental month. For power wheelchairs and other items where the beneficiary may choose to purchase, the supplier must document the rent-or-purchase option with BR, BP or BU.
| BR | Beneficiary was informed of the purchase and rental options and has elected to rent the item |
| BP | Beneficiary was informed of the purchase and rental options and has elected to purchase the item |
| BU | Beneficiary was informed of the purchase and rental options and, after 30 days, has not informed the supplier of a decision |
| KH | DMEPOS item, initial claim, purchase or first month rental |
| KI | DMEPOS item, second or third month rental |
| KJ | DMEPOS item, parenteral enteral nutrition (PEN) pump or capped rental, months four to fifteen |
| LL | Lease/rental (use when DME equipment rental is to be applied against the purchase price) |
Maintenance, Replacement and Repair
| MS | Six-month maintenance and servicing fee for reasonable and necessary parts and labor not covered under any manufacturer or supplier warranty |
| RA | Replacement of a DME, orthotic or prosthetic item |
| RB | Replacement of a part of a DME, orthotic or prosthetic item furnished as part of a repair |
| CG | Policy criteria applied |
| A1–A9 | Dressing for one to nine wounds (the number indicates how many wounds are being dressed) |
Note: the former RP (replacement and repair) modifier was deleted and replaced by RA and RB. Claims still using RP will reject.
Oxygen and Oxygen Equipment Modifiers
Oxygen equipment is billed as a rental with RR, plus the flow-rate modifier that matches the prescribed liters per minute (LPM).
| QE | Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (LPM) |
| QF | Prescribed amount of stationary oxygen while at rest exceeds 4 LPM and portable oxygen is prescribed |
| QG | Prescribed amount of stationary oxygen while at rest is greater than 4 LPM |
| QH | Oxygen-conserving device is being used with an oxygen delivery system |
Functional Level Modifiers for Lower-Limb Prosthetics
| K0 | Beneficiary does not have the ability or potential to ambulate or transfer safely, and a prosthesis does not enhance quality of life or mobility |
| K1 | Ability or potential to use a prosthesis for transfers or ambulation on level surfaces at a fixed cadence (limited household ambulator) |
| K2 | Ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs or uneven surfaces (limited community ambulator) |
| K3 | Ability or potential for ambulation with variable cadence (community ambulator) |
| K4 | Ability or potential for ambulation that exceeds basic skills, with high impact, stress or energy levels (typical of children, active adults or athletes) |
Osteogenesis Stimulators
Use the KF modifier (item designated by the FDA as a Class III device) with osteogenesis stimulator codes E0747, E0748 and E0760.
Tape (A4450, A4452)
Tape codes A4450 and A4452 require a modifier that identifies the supply it is used with:
| AU | Item furnished in conjunction with a urological, ostomy or tracheostomy supply |
| AV | Item furnished in conjunction with a prosthetic device, prosthetic or orthotic |
| AW | Item furnished in conjunction with a surgical dressing |
| AX | Item furnished in conjunction with dialysis services |
Inhalation Drug Formulation Modifiers
| 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 and Item-Specific Modifiers
| RT / LT | Right side / left side. Required for items such as refractive lenses, eye prostheses, facial prostheses and orthopedic footwear |
| KM | Replacement of facial prosthesis including new impression/moulage |
| KN | Replacement of facial prosthesis using previous master model |
| KS | Glucose monitor supply for a diabetic beneficiary not treated with insulin |
| KX | Requirements specified in the medical policy have been met. Used across many LCDs, including external infusion pumps, home dialysis supplies, nebulizers, hospital beds, walkers and cervical traction devices |
Upgrades, ABN and Coverage Modifiers
These modifiers communicate liability. Pairing them correctly with KX decides whether a claim pays, denies to the beneficiary, or denies to the supplier.
| EY | No physician or other licensed health care provider order for this item or service |
| GA | Waiver of liability statement (ABN) issued as required by payer policy |
| GZ | Item or service expected to be denied as not reasonable and necessary, and no ABN is on file |
| GY | Item or service statutorily excluded or does not meet the definition of any Medicare benefit |
| GK | Reasonable and necessary item or service associated with a GA or GZ modifier |
| GL | Medically unnecessary upgrade provided instead of a non-upgraded item, no charge, no ABN |
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Claim-Level and Competitive Bidding Modifiers
| 99 | Multiple modifiers (use when more than four modifiers apply to a line) |
| KB | Beneficiary requested upgrade for ABN, more than four modifiers identified on claim |
| KL | DMEPOS item delivered via mail |
| KT | Beneficiary resides in a competitive bidding area and travels outside that area to receive a competitive bid item |
| KV | DMEPOS item subject to competitive bidding furnished as part of a professional service |
| J4 | DMEPOS item subject to competitive bidding furnished by a hospital upon discharge |
| KE, KG, KK, KU, KW, KY | Competitive bidding program identifiers (bid-round and item-group modifiers). Check the current DME MAC instructions, because their use depends on whether the item is in an active bidding round |
Tips for Avoiding DME Modifier Denials
- Check each modifier against the applicable LCD and Policy Article before billing. Many policies require a specific modifier combination.
- Never append KX unless the medical record supports every coverage criterion.
- Use GA only when a valid, signed ABN is on file. Otherwise use GZ.
- Sequence pricing modifiers (NU, RR, UE) first, followed by payment and informational modifiers.
- Review the quarterly CMS HCPCS update, because modifiers are added, revised and deleted throughout the year.
As covered above, DME modifiers are two-character alpha or numeric codes added to the end of HCPCS codes to describe exactly what was supplied and why. Accurate modifiers mean faster payment and fewer denials, and they protect the supplier at audit.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing services. Our certified coders follow current DME billing and coding guidelines to make sure the right procedure codes and modifiers are used. If denials are building up, our revenue cycle management services can help recover lost revenue. To learn more about our DME billing and coding services, contact us at info@medicalbillersandcoders.com or call us at 888-357-3226.
A DME modifier is a two-character alpha or numeric code added to HCPCS codes to provide specific information about the equipment being billed. These modifiers clarify the condition under which the equipment is provided, such as rental, purchase, or maintenance, helping to ensure accurate reimbursement from insurance providers.
Some commonly used DME modifiers include:
NU – Purchase of new DME
RR – Rental of DME
UE – Purchase of used DME
NR – New when rented
These modifiers specify whether the equipment was rented or purchased, helping in proper claim processing.
Oxygen equipment modifiers specify the amount and type of oxygen prescribed. For example:
QE – Prescribed oxygen is less than 1 LPM (liters per minute)
QF – Prescribed oxygen exceeds 4 LPM and includes portable oxygen
QH – When an oxygen-conserving device is used
These modifiers ensure the correct billing for oxygen-related services and equipment.
K-series modifiers (K0 to K4) show a beneficiary’s functional level for lower-limb prostheses. They range from K0 (no ability or potential to ambulate) to K4 (high-activity ambulation beyond basic skills, typical of children, active adults or athletes). The documented level must support the prosthetic components billed.
The GA modifier is used when a supplier has an Advance Beneficiary Notice (ABN) on file. This signifies that the patient has been informed that Medicare may not cover the item or service, and the patient agrees to be responsible for the payment if Medicare denies the claim.
GA means a valid Advance Beneficiary Notice (ABN) is on file, so the beneficiary can be billed if Medicare denies the item. GZ means a denial is expected but no ABN was obtained, so the supplier cannot bill the beneficiary.
Append KX only when every coverage criterion in the applicable LCD is met and documented in the medical record. Billing KX without supporting documentation is a common audit finding.
Up to four modifiers fit on a claim line. When more apply, report 99 (or KB for a beneficiary-requested upgrade with an ABN) and list the remaining modifiers in the claim narrative.
Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.
