• Common Modifiers for DME

    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 the first-month rental by including the appropriate modifier code, and bill your claims in sequential order. Inexpensive or Routinely Purchased DME Inexpensive DME-This category is defined as equipment whose purchase price does not exceed $150. Routinely Purchased-This category consists of equipment that is purchased at least 75% of the time. Payment for this type of equipment is for rental or lump-sum purchase.  The total payment may not exceed the actual charge or the fee for purchase. Common modifiers used in this category are: RR…

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