www.medicalbillersandcoders.com Follow us: Know your DME Modifiers 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
www.medicalbillersandcoders.com Follow us: Know your DME Modifiers 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)
www.medicalbillersandcoders.com Follow us: Know your DME Modifiers 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
www.medicalbillersandcoders.com Follow us: Know your DME Modifiers 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
www.medicalbillersandcoders.com Follow us: Know your DME Modifiers 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
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KB or 99
KL (delivered by mail), KV, KT, J4, KE, KG, KK, KU, KW, KY
items
their bidding.
Know your DME Modifiers 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:
used in cases of 4 or more modifiers.
Refers to DMEPOS
and