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DME

Annette Posted Mon 03rd of December, 2018 09:16:01 AM
I am billing medicare for a new DME company. Are there any modifiers or anything else that needs to be submitted? For example, for chiro, you need to include the x-ray date and the AT modifier. Are there any requirements like that for billing DME? Thanks!
SuperCoder Answered Tue 04th of December, 2018 09:47:37 AM

Hi,

In addition to an appropriate HCPCS code for the DME item, many HCPCS codes require a modifier. The modifiers are used to provide more information about the item. For example, the modifier tell that an item is new, used, or rented on a capped basis.

For example:

  RR - Rental

  NU - Purchase of new equipment

  UE - Purchase of used equipment

 

Modifiers used for replacement and repair:

RA – Replacement of a DME item due to loss, irreparable damage, or theft. This is used on the first-month rental claim for a replacement item.

RB – Replacement of a part of DME as part of a repair.

 

For billing HCPCS code for the DME item there should be a medical necessity. If you need DME in your home, your doctor or treating practitioner (like a nurse practitioner, physician assistant, or clinical nurse specialist) must prescribe the type of equipment you need by filling out an order. For some equipment, Medicare may also require your doctor to provide additional information documenting your medical need for the equipment. Your supplier will work to make sure your doctor submits all required information to Medicare. If your needs and/or condition changes, your doctor must complete and submit a new, updated order.

Also check the specific guidelines (if any) in order to bill the procedure.

 

For further details, please check the below link:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c20.pdf

 

Thanks

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