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Aetna DME

Darshna Posted Wed 31st of July, 2019 15:29:12 PM
Hey what modifier should be used while billing for DME codes to aetna ?
SuperCoder Answered Thu 01st of August, 2019 04:25:43 AM

Hello Darshna,

Thank you for your question.


As per CMS, below listed modifiers are applicable for DMEPOS codes.



Item furnished in conjunction with a urological, ostomy, or tracheostomy supply


New equipment


Item furnished in conjunction with a prosthetic device, prosthetic or orthotic


Item furnished in conjunction with a surgical dressing


Rental (use the 'rr' modifier when dme is to be rented)


Used durable medical equipment


Item designated by fda as class iii device


Replacement of facial prosthesis including new impression/moulage


Replacement of facial prosthesis using previous master model


Replacement of special power wheelchair interface


Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment


Dmepos item subject to dmepos competitive bidding program number 3


Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (lpm) and portable oxygen is prescribed


Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed



Note: You need to check with your respective payer for any other modifier(s) that need to be reported with the claim, as commercial payer(s) might have their specific guidelines for DME services.


Hope that helps!



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