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 make the HCPCS code valid before claim processing. Here we shared the DME Modifiers which are divided into several categories:
DME Modifiers are divided into several categories:
Routinely purchased Pricing Modifiers:
| NU | Purchase of New DME |
| RR | Rented DME |
| UE | Purchase of Used DME |
| NR | New when rented |
Capped Rental Items and modifiers: One can use RR in this category except for wheelchairs where the patient is allowed the option to buy one. Others are:
| BR | The receiver has elected to rent |
| BP | The receiver has elected to purchase |
| BU | Rent or purchase not selected past 30 days despite a notification |
| KH | Purchase or First rental month |
| KI | Second and third rental months |
| KJ | Fourth to thirteenth rental months |
| KR | Rental but partial month billing |
| LL | Lease/Rental (Medicaid) |
Other Categories:
| MS | Maintenance DME |
| MM | Maintenance and Servicing |
| RP | Replacement and repair |
| A1 to A9 | Surgical Dressings |
| CG | Spinal Orthosis |
DME Modifiers for Oxygen and the Corresponding equipment:
| RR | Rental |
| QE | Prescribed oxygen is less than 1 LPM |
| QF | Prescribed oxygen exceeds 4 LPM and portable oxygen is prescribed |
| QG | Prescribed oxygen is greater than 4 LPM |
| QH | When an oxygen-conserving device is used with an oxygen delivery system |
Functional DME Modifiers for Prosthetics and Orthotics:
| K0 to K4 | Used for various categories in Lower Limb Prostheses |
| RA | Replacement of DME, orthotic or prosthetic |
| QF | Replacement of a part of the above |
Osteogenesis Stimulators:
| KF | modifier (FDA Class III device) to be used with E0747, E0748, and E0760. |
Tape (A4450, A4452):
| AX | Items in concurrence with dialysis services |
| AU | Items in urological, ostomy, or tracheostomy supply |
| AV | Items with a prosthetic or orthotic device |
| AW | Items in surgical dressing with billing codes for tape A4450 and A4452 |
Drug Formulations (pedorthics.org):
| KO | Single drug unit dose formulation |
| KP | The first drug of a multiple-drug unit dose formulation |
| KQ | Second or subsequent drug of a multiple drug unit dose formulation |
Anatomic DME Modifiers:
| RT (Right) and LT (Left) | modifiers are used in cases such as refractive lenses, eye prostheses, facial prostheses, orthopedic footwear, etc. |
| KM | Replacement of facial prosthesis including new impression |
| KN | Replacement of facial prosthesis using previous master model |
| KX | Used in cases such as external infusion pumps, home dialysis supplies, nebulizers, hospital beds, walkers, cervical traction devices, etc. |
| KS | The patient is glucose monitor supplied, not insulin |
Up-gradation/Prescription requirement:
| EY | Used when a supplier does not have a doctor’s order. |
| GA | When a supplier has an ABN on file. |
| GZ | Item denied as not reasonable. |
| GY | When an item is not covered and does not have a Medicare benefit. |
| GK and GL | modifiers are upgrades wherein GK is a necessary upgrade of the equipment whereas GL is not. |
Added modifiers:
| KB or 99 | used in cases of 4 or more modifiers. |
| KL (delivered by mail), KV, KT, J4, KE, KG, KK, KU, KW, KY | Refers to DMEPOS items and their bidding. |
As mentioned above, DME modifiers are two-character alpha or numeric codes that are added to the end of HCPCS codes to elucidate the benefits when billed. Adding these augments the reimbursement process.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing services. Our certified coders follow accurate DME billing and coding guidelines to ensure an accurate selection of procedure codes along with modifiers. To know more about our DME billing and coding services, contact us directly at info@medicalbillersandcoders.com or call us at 888-357-3226.
FAQs
1. What is a DME Modifier, and why is it important in medical billing?
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.
2. What are the common DME modifiers used for rental and purchase of equipment?
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.
3. How are oxygen equipment modifiers applied in DME billing?
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.
4. What do the K-series modifiers represent in prosthetics and orthotics billing?
K-series modifiers, such as K0 to K4, 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.
5. When should the GA modifier be used in DME billing?
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.
