Top Modifiers used in DME Billing

Top Modifiers Used In DME Billing

Durable Medical Equipment billing is a highly complicated billing process as it involves several inclusions. Missing out even a minute detail can lead to rejection or denial of the claims. Modifiers play a crucial role in such billings apart from the HCPCS codes as per the DME supplies. Modifiers provide the details and the description of the DME items and decide on the claims processed on DME. Along with the HCPCS codes, the DME medical billing also uses the ICD-10 diagnosis code. These codes determine the medical condition for which the DME item was prescribed in the first place.

Modifiers- A Look

All HCPCS codes do not require a modifier, but most of them come along with one. A modifier mentions whether the DME item is new or used, or rented on a capped mode. In case the DME is on capped rental, only the modifiers can show the difference in which month the DME billing is being done. Therefore, the incorrect mention of these modifiers can lead to rejection or denial of the claims. That’s why it is necessary to be aware of the common modifiers used in DME billing. 

Let’s take a look at the commonly used modifiers in the DME medical billing:

Common Modifier:

RR: Rental

NU: New Equipment Purchase

UE: Used Equipment Purchase

Categories for which Common Modifiers are used:

Modifiers RR, NU, and UE can be used for the following categories:

  • Oxygen Equipment (without contents)
  • Capped Rental Items
  • Items with the need for Substantial and Frequent Servicing
  • Inexpensive and Routinely Purchased items

In the case of capped rental items along with RR, the following modifiers need to be added to indicate the rental period:

KH: Initial claim & first-month rental 

KI: Second & third capped rental months

KJ: Fourth to thirteenth capped rental months

Maintenance and Servicing:

MS is the modifier used for the six-month maintenance and servicing fee. This modifier is used for labor and parts that remain uncovered under any supplier or manufacturer’s warranty. Moreover, the payments for maintenance and service are made every 6 months but only after the equipment is initially owned by the member.

Replacement and Repair

RA is a modifier that is applicable for a DME item replacement with respect to non-repair damage, theft, or loss. However, this DME code needs to be used only for the first-month rental claim for a replacement DME item.

RB is another modifier applicable for a part of DME item replacement due to repairs if the need arises.

KX Modifier: Documentation on File

The KX Modifier indicates the existence of required documentation on file to support the DME item’s medical necessity. This modifier is applicable for the following categories:

  • Hospital beds
  • Walkers
  • Orthopedic footwear
  • Patient lifts
  • CPAP
  • Wheelchair seating
  • Pre-fabricated knee orthoses
  • Cervical traction unit
  • External infusion pumps
  • Nebulizers
  • Commodes and many more

Right and Left Modifiers:

RT: For Right

LT: For Left

Modifiers RT and LT can be used for the following categories:

  • External breast prosthesis
  • AFO/ KAFO
  • Orthopedic footwear
  • Eye prosthesis
  • Lower limb prosthesis
  • Therapeutic shoes for diabetic persons
  • Wheelchair options/ accessories

Modifiers for Complex Power Wheelchairs only:

BP: Elected to purchase by the member 

BR: Elected to rent by the member 

Note: At the time of billing for medical supplies such as ostomy bags, syringes, etc., modifiers are not needed.

Conclusion

These modifiers are just part of DME billing, and there are multiple more modifiers that are required to be specified and remembered while submitting the claims. However, practically it is not that easy for your DME practice to balance patient care and DME billing with the correct modifiers. It would be better to outsource DME medical billing in India rather than training in-house professionals for such knowledge. Connect with the Info Hub experts right now and get rid of DME medical billing stress