Equipment that gives therapeutic advantages to a patient and is basically for the long haul and home use is named Durable Medical Equipment (DME). Because of a wide assortment of models for DME, Places for Medicare and Medicaid Administrations (CMS) established the Healthcare Common Procedure Coding System (HCPCS) and modifiers which relate to the boundaries policy and LCD and make the HCPCS code legitimate before claim processing.
Modifiers are divided into several categories:
Routinely purchased Pricing Modifiers:
| NU | Purchase of New DME |
| RR | Rented DME |
| UE | Purchase of Used DME |
| NR | New when rented |
Capped Rental Items and modifiers: One can utilize RR in this classification with the exception of wheelchairs where the patient is permitted the choice to get one. Others are:
| BR | The receiver has elected to rent |
| BP | The receiver has elected to purchase |
| BU | Rent or purchase not selected past 30 days despite a notification |
| KH | Purchase or First rental month |
| KI | Second and third rental months |
| KJ | Fourth to thirteenth rental months |
| KR | Rental but partial month billing |
| LL | Lease/Rental (Medicaid) |
Other Categories:
| MS | Maintenance DME |
| MM | Maintenance and Servicing |
| RP | Replacement and repair |
| A1 to A9 | Surgical Dressings |
| CG | Spinal Orthosis |
Modifiers for Oxygen and the Corresponding equipment:
| RR | Rental |
| QE | Prescribed oxygen is less than 1 LPM |
| QF | Prescribed oxygen exceeds 4 LPM and portable oxygen is prescribed |
| QG | Prescribed oxygen is greater than 4 LPM |
| QH | When an oxygen conserving device is used with an oxygen delivery system |
Functional Modifiers for Prosthetics and Orthotics:
| K0 to K4 | Used for various categories in Lower Limb Prostheses |
| RA | Replacement of DME, orthotic or prosthetic |
| QF | Replacement of a part of the above |
Osteogenesis Stimulators:
| KF | modifier (FDA Class III device) to be used with E0747, E0748, and E0760. |
Tape (A4450, A4452):
| AX | Items in concurrence with dialysis services |
| AU | Items in urological, ostomy, or tracheostomy supply |
| AV | Items with a prosthetic or orthotic device |
| AW | Items in surgical dressing with billing codes for tape A4450 and A4452 |
Drug Formulations (pedorthics.org):
| KO | Single drug unit dose formulation |
| KP | The first drug of a multiple drug unit dose formulation |
| KQ | Second or subsequent drug of a multiple drug unit dose formulation |
Anatomic Modifiers:
| RT (Right) and LT (Left) | modifiers are used in cases such as refractive lenses, eye prosthesis, facial prosthesis, orthopedic footwear, etc. |
| KM | Replacement of facial prosthesis including new impression |
| KN | Replacement of facial prosthesis using previous master model |
| KX | Used in cases such as external infusion pumps, home dialysis supplies, nebulizers, hospital beds, walkers, cervical traction devices, etc. |
| KS | The patient is glucose monitor supplied, not insulin |
Up-gradation/Prescription requirement:
| EY | Used when a supplier does not have a doctor’s order. |
| GA | When a supplier has an ABN on file. |
| GZ | Item denied as not reasonable. |
| GY | When an item is not covered and does not have a Medicare benefit. |
| GK and GL | modifiers are upgrades wherein GK is a necessary upgrade of the equipment whereas GL is not. |
Added modifiers:
| KB or 99 | used in cases of 4 or more modifiers. |
| KL (delivered by mail), KV, KT, J4, KE, KG, KK, KU, KW, KY | Refers to DMEPOS items and their bidding. |
As referenced above, DME modifiers are two-character alpha or numeric codes that are added to the furthest limit of HCPCS codes to elucidate the advantages when billed. Adding these augments the reimbursement process.
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