Know your DME Modifiers

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Know your DME Modifiers

• Medical Billers and Coders

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Equipment that provides therapeutic benefits to a
patient and is primarily for long-term and home
use is termed as Durable Medical Equipment (DME).
Due to a wide variety of models for DME, Centers
for Medicare and Medicaid Services (CMS)
instituted the Healthcare Common Procedure Coding
System (HCPCS) and modifiers which correspond to
the parameters policy and LCD and make the HCPCS
code valid before claim processing.
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• Modifiers are divided into several categories
• Routinely purchased Pricing Modifiers
• Capped Rental Items and modifiers
• Modifiers for Oxygen and the Corresponding
  equipment
• Functional Modifiers for Prosthetics and
  Orthotics
• Osteogenesis Stimulators
• Tape (A4450, A4452)
• Drug Formulations (pedorthics.org)
• Anatomic Modifiers
• Up-gradation/Prescription requirement
• Added modifiers

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Routinely purchased Pricing Modifiers
NU Purchase of New DME
RR Rented DME
UE Purchase of Used DME
NR New when rented
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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)
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Other Categories
MS Maintenance DME
MM Maintenance and Servicing
RP Replacement and repair
A1 to A9 Surgical Dressings
CG Spinal Orthosis
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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
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Functional 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.
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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
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Anatomic Modifiers
RT (Right) and LT (Left) modifiers are used in cases such as refractive lenses, eye prosthesis, facial prosthesis, 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.
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Up-gradation/Prescription requirement
EY Used when a supplier does not have a doctors 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.
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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.
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