Durable medical equipment (DME) provides therapeutic benefits for long-term home use. The Centers for Medicare and Medicaid Services uses HCPCS codes and modifiers to identify DME parameters and make codes valid for claims processing. Modifiers are divided into categories like routinely purchased items, capped rental items, oxygen equipment, prosthetics, and more. They provide essential details about equipment usage, replacements, and prescriptions to facilitate reimbursement.

1. KNOW YOUR
DME MODIFIERS
MEDICAL BILLERS AND CODERS

2. 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.

3. 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

4. Routinely purchased Pricing Modifiers:
NU Purchase of New DME
RR Rented DME
UE Purchase of Used DME
NR New when rented

5. 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)

6. Other Categories:
MS Maintenance DME
MM Maintenance and Servicing
RP Replacement and repair
A1 to A9 Surgical Dressings
CG Spinal Orthosis

7. 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

8. 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.

9. 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

10. 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.

11. 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.

12. 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.

13. Address
Wilmington
108 West, 13th street, Wilmington, DE 19801
Texas
539 W. Commerce St #1482 Dallas, TX 75208
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