Durable Medical Equipment Modifiers and Units

The correct billing of rented and purchased durable medical equipment (DME) items is critical for the accuracy of claim pricing and payment. Claim editing ensures the modifiers and units are billed appropriately.

Per the DME payment policy, correct modifier usage includes the following:

DME Rentals: Monthly and Daily/Partial Months

• Applicable DME codes which are rented, must be appended with a rental modifier:
  • RR – Rental (monthly rentals)
  • KR – Rental for partial month/daily rentals
• The units of service for a rented DME item must correspond with the modifier:
  • Monthly rentals (modifier RR): The unit of service is always one which represent the item being rented for one full month. Each month rented should be billed on a separate claim line. Units greater than one will be denied.
  • Daily rentals (modifier KR): The units of service must match the number of days If a date span is billed, the units of service must match the number of days in the date span in order to be reimbursed.

DME Purchased Items

• When a piece of DME is purchased outright, whether as a purchase of a new item or of a used item, one of the following modifiers is required:
  • NU – New equipment
  • UE – Used equipment
• Depending on the specific DME procedure code, the unit of service will be one, unless the code description indicates otherwise (e.g., each).

DME Replacement

If a piece of DME (whether currently rented or previously purchased) needs to be replaced, modifier RA-“Replacement of a DME, Orthotic or Prosthetic item” needs to be appended as a secondary modifier:

• Modifier RA would be added after either modifier RR (ex. RR-RA) for a rental DME item replacement or after modifier NU (ex. NU-RA) for a purchased DME item replacement.
• If a replacement DME item is being rented, modifiers RR-RA would be appended for the first rental month claim only. All subsequent rental months would be submitted with modifier RR only.
• The patient medical records must document the reason/need for the replacement and be made available for review upon request.

The payment policy “Durable Medical Equipment (DME)/Home Medical Equipment (HME)” has been expanded to address the existing and upcoming DME edits. To review the criteria/guidelines on correct modifier usage for rented, purchased and replacement DME, review the policy in the Availity provider portal.