Upcoming Durable Medical Equipment Edits

Effective for claim process dates on and after July 5, 2024, durable medical equipment (DME) edits will be added to the claims editor.

Some of the upcoming DME edits include:

• Correct modifier usage to represent left- or right-side application.
• Correct modifier usage to identify whether DME is purchased or rented.
• Requiring finger and toe modifiers to be appended to applicable equipment.
• Correct billing of oxygen equipment rentals and associated supplies.
• Appending functional modifiers to prosthetics.

The payment policy “Durable Medical Equipment (DME)/Home Medical Equipment (HME)” is now expanded to address these new DME edits and can be viewed in the Availity provider portal.