{"id":6244,"date":"2016-05-10T10:28:43","date_gmt":"2016-05-10T10:28:43","guid":{"rendered":"http:\/\/www.medicalbillersandcoders.com\/blog\/?p=6244"},"modified":"2025-07-09T09:04:37","modified_gmt":"2025-07-09T09:04:37","slug":"know-your-dme-modifiers","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/know-your-dme-modifiers\/","title":{"rendered":"Know your DME Modifiers"},"content":{"rendered":"

Equipment that provides therapeutic benefits to a patient and is primarily for long-term and home use is termed DME.<\/strong><\/em> Due to a wide variety of models for DME, the Centers for Medicare and Medicaid Services (CMS) instituted the Healthcare Common Procedure Coding System (HCPCS) and modifiers that correspond to the parameters policy and LCD and make the HCPCS code valid before claim processing. Here we shared the DME Modifiers which are divided into several categories:<\/p>\n

DME Modifiers are divided into several categories<\/strong>:<\/h2>\n

Routinely purchased Pricing Modifiers:<\/b><\/h3>\n\n\n\n\n\n\n
NU<\/td>\nPurchase of New DME<\/td>\n<\/tr>\n
RR<\/td>\nRented DME<\/td>\n<\/tr>\n
UE<\/td>\nPurchase of Used DME<\/td>\n<\/tr>\n
NR<\/td>\nNew when rented<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Capped Rental Items and modifiers:\u00a0<\/b><\/h3>\n

One can use RR in this category except for wheelchairs where the patient is allowed the option to buy one. Others are:<\/p>\n\n\n\n\n\n\n\n\n\n\n
BR<\/td>\nThe receiver has elected to rent<\/span><\/td>\n<\/tr>\n
BP<\/td>\nThe receiver has elected to purchase<\/td>\n<\/tr>\n
BU<\/td>\nRent or purchase not selected past 30 days despite a notification<\/td>\n<\/tr>\n
KH<\/td>\nPurchase or First rental month<\/td>\n<\/tr>\n
KI<\/td>\nSecond and third rental months<\/td>\n<\/tr>\n
KJ<\/td>\nFourth to thirteenth rental months<\/td>\n<\/tr>\n
KR<\/td>\nRental but partial month billing<\/td>\n<\/tr>\n
LL<\/td>\nLease\/Rental (Medicaid)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Other Categories:<\/b><\/h3>\n\n\n\n\n\n\n\n
MS<\/td>\nMaintenance DME<\/td>\n<\/tr>\n
MM<\/td>\nMaintenance and Servicing<\/td>\n<\/tr>\n
RP<\/td>\nReplacement and repair<\/td>\n<\/tr>\n
A1 to A9<\/td>\nSurgical Dressings<\/td>\n<\/tr>\n
CG<\/td>\nSpinal Orthosis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

DME Modifiers for Oxygen and the Corresponding equipment:<\/b><\/h3>\n\n\n\n\n\n\n\n
RR<\/td>\nRental<\/td>\n<\/tr>\n
QE<\/td>\nPrescribed oxygen is less than 1 LPM<\/td>\n<\/tr>\n
QF<\/td>\nPrescribed oxygen exceeds 4 LPM and portable oxygen is prescribed<\/td>\n<\/tr>\n
QG<\/td>\nPrescribed oxygen is greater than 4 LPM<\/td>\n<\/tr>\n
QH<\/td>\nWhen an oxygen-conserving device is used with an oxygen delivery system<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Functional DME Modifiers for Prosthetics and Orthotics:<\/b><\/h3>\n\n\n\n\n\n
K0 to K4<\/td>\nUsed for various categories in Lower Limb Prostheses<\/td>\n<\/tr>\n
RA<\/td>\nReplacement of DME, orthotic or prosthetic<\/td>\n<\/tr>\n
QF<\/td>\nReplacement of a part of the above<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Osteogenesis Stimulators:<\/b><\/h3>\n\n\n\n
KF<\/strong><\/td>\nmodifier (FDA Class III device) to be used with E0747, E0748, and E0760.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Tape (A4450, A4452):<\/b><\/h3>\n\n\n\n\n\n\n
AX<\/td>\nItems in concurrence with dialysis services<\/td>\n<\/tr>\n
AU<\/td>\nItems in urological, ostomy, or tracheostomy supply<\/td>\n<\/tr>\n
AV<\/td>\nItems with a prosthetic or orthotic device<\/td>\n<\/tr>\n
AW<\/td>\nItems in surgical dressing with billing codes for tape A4450 and A4452<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Drug Formulations (pedorthics.org<\/i>):<\/b><\/h3>\n\n\n\n\n\n
KO<\/td>\nSingle drug unit dose formulation<\/td>\n<\/tr>\n
KP<\/td>\nThe first drug of a multiple-drug unit dose formulation<\/td>\n<\/tr>\n
KQ<\/td>\nSecond or subsequent drug of a multiple drug unit dose formulation<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Anatomic DME Modifiers<\/b>:<\/h3>\n\n\n\n\n\n\n\n
RT (Right) and LT (Left)<\/td>\nmodifiers are used in cases such as refractive lenses, eye prostheses, facial prostheses, orthopedic footwear, etc.<\/td>\n<\/tr>\n
KM<\/td>\nReplacement of facial prosthesis including new impression<\/td>\n<\/tr>\n
KN<\/td>\nReplacement of facial prosthesis using previous master model<\/td>\n<\/tr>\n
KX<\/td>\nUsed in cases such as external infusion pumps, home dialysis supplies, nebulizers, hospital beds, walkers, cervical traction devices, etc.<\/td>\n<\/tr>\n
KS<\/td>\nThe patient is glucose monitor supplied, not insulin<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Up-gradation\/Prescription requirement:<\/b><\/h3>\n\n\n\n\n\n\n\n
EY<\/td>\nUsed when a supplier does not have a doctor’s order.<\/td>\n<\/tr>\n
GA<\/td>\nWhen a supplier has an ABN on file.<\/td>\n<\/tr>\n
GZ<\/td>\nItem denied as not reasonable.<\/td>\n<\/tr>\n
GY<\/td>\nWhen an item is not covered and does not have a Medicare benefit.<\/td>\n<\/tr>\n
GK and GL<\/td>\nmodifiers are upgrades wherein GK is a necessary upgrade of the equipment whereas GL is not.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Added modifiers:<\/b><\/h3>\n\n\n\n\n
KB or 99<\/td>\nused in cases of 4 or more modifiers.<\/td>\n<\/tr>\n
KL (delivered by mail), KV, KT, J4, KE, KG, KK, KU, KW, KY<\/td>\nRefers to DMEPOS items and their bidding.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

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

Medical Billers and Coders (MBC)<\/strong> is a leading medical billing company<\/a> providing complete medical billing services.<\/p>\n

Our certified coders follow accurate DME billing<\/a> and coding guidelines to ensure an accurate selection of procedure codes along with modifiers.\u00a0To know more about our DME billing and coding services, contact us directly at info@medicalbillersandcoders.com<\/a> or call us at\u00a0888-357-3226<\/a>.<\/strong><\/p>\n

FAQs<\/strong><\/h2>\n\n\n
1. What is a DME Modifier, and why is it important in medical billing?<\/strong><\/strong>

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.<\/p> <\/div>

2. What are the common DME modifiers used for rental and purchase of equipment?<\/strong><\/strong>

Some commonly used DME modifiers include:NU<\/strong> \u2013 Purchase of new DMERR<\/strong> \u2013 Rental of DMEUE<\/strong> \u2013 Purchase of used DMENR<\/strong> \u2013 New when rentedThese modifiers specify whether the equipment was rented or purchased, helping in proper claim processing.<\/p> <\/div>

3. How are oxygen equipment modifiers applied in DME billing?<\/strong><\/strong>

Oxygen equipment modifiers specify the amount and type of oxygen prescribed. For example:QE<\/strong> \u2013 Prescribed oxygen is less than 1 LPM (liters per minute)QF<\/strong> \u2013 Prescribed oxygen exceeds 4 LPM and includes portable oxygenQH<\/strong> \u2013 When an oxygen-conserving device is usedThese modifiers ensure the correct billing for oxygen-related services and equipment.<\/p> <\/div>

4. What do the K-series modifiers represent in prosthetics and orthotics billing?<\/strong><\/strong>

K-series modifiers, such as K0<\/strong> to K4<\/strong>, are used to categorize lower limb prosthetics based on the patient’s functional level. These modifiers help indicate the medical necessity and appropriate level of prosthetic devices, affecting claim approvals and reimbursement.<\/p> <\/div>

5. When should the GA modifier be used in DME billing?<\/strong><\/strong>

The GA<\/strong> 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.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"

Equipment that provides therapeutic benefits to a patient and is primarily for long-term and home use is termed DME. Due to a wide variety of models for DME, the Centers for Medicare and Medicaid Services (CMS) instituted the Healthcare Common Procedure Coding System (HCPCS) and modifiers that correspond to the parameters policy and LCD and […]<\/p>\n","protected":false},"author":2,"featured_media":13746,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[155,790,3753,3754,864,865,866,3102,369,117,12],"class_list":["post-6244","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dme-billing-services","tag-centers-for-medicare-and-medicaid-services","tag-dme","tag-dme-billing-and-coding-guidelines","tag-dme-billing-and-coding-services","tag-dme-billing-modifier","tag-dme-billing-modifier-chaos","tag-dme-modifiers","tag-leading-medical-billing-company","tag-mbc","tag-medical-billers-and-coders-2","tag-medical-billing-services-2"],"yoast_head":"\nDME Modifiers for DME Billing Services<\/title>\n<meta name=\"description\" content=\"Are you struggling to deal with your DME Modifiers Billing chaos? 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