November 16, 2017
In response to your inquiries, we're revising the Durable Medical Equipment (DME)/Home Medical Equipment (HME) payment policy to provide more examples of the DME categories.
Based on the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule as maintained by the Centers for Medicare and Medicaid Services, we have created three categories of DME equipment that are distinguished by appending a modifier. These code groups are:
- Rental to Purchase - Equipment that is rented for a designated period of months after which the piece of equipment is considered owned or purchased by the member.
- Rental Only Services - Equipment which is rarely or never purchased but is rented on a continuous basis.
- Purchase Only Services - Equipment that is purchased only.
Codes in each of these categories of equipment must be identified by appending one of the following modifiers to the DME procedure code:
Purchase Modifiers:
- NU - New equipment
- NR - New when rented. (Use the NR modifier when DME which was new at the time of rental is subsequently purchased. Providers should bill the purchase price of the equipment.)
- RA - Replacement of a DME orthotic or prosthetic item, or
- UE - Used DME
Rental Modifiers:
- RR - Rental (Use the RR modifier when DME is to be rented)
- LL - Lease/rental (Use the LL modifier when DME equipment rental is to be applied against the purchase price), or
- KR - Rental item-billing for partial month (Use to indicate daily rentals)
To learn more of the details on the revision to the DME Payment Policy, and a link to the list of codes, review the policy posted at the end of November.