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Durable Medical Equipment/Prosthetics/Orthotics/Supplies (DMEPOS) Modifiers


Provider Administrative Policy

Section
Claims Submission
Policy Date
December 2006
Status/Date
Revised/February 2014
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Durable Medical Equipment/Prosthetics/Orthotics/Supplies (DMEPOS) Modifiers

When submitting a claim for durable medical equipment/prosthetics/orthotics/supplies (DMEPOS) that can be rented, leased or purchased, the HCPCS code must have the correct modifier indicating rental (RR), lease (LL) or purchase (NU).

If the correct modifier is not attached to the HCPCS code, payment may be impacted, your hardcopy claim may be returned or the electronic claim may be rejected on your error and acceptance report.

When no modifier is submitted pricing will default to rental (RR) pricing. Exception: Breast pumps submitted with neither NU or RR modifiers will default to purchase pricing.

Purchase price will be calculated from the allowance that was established at initial date of prior authorization.

Rental items will be allowed up to the purchase price of that item, regardless of time frames. When an item is not indicated for purchase by CMS, Blue Cross of Idaho will calculate a purchase price at ten times the rental price.

Modifiers QE, QF and QG should only be used on codes E0424, E0439, E1390 and E1391 when decreased or increased oxygen flow is required to treat the patient.

E1353 and E1355 (oxygen accessories) are purchase items only, but will only be allowed without a prior authorization if the total purchase price is under $500. Modifier NU should be used when billing these items.  Post claim review may occur to determine medical necessity. 

Modifier AU must be used when furnishing items in conjunction with a urological, ostomy or tracheostomy supply.

Modifier AW must be used with compression stockings in conjunction with a surgical dressing.


Policy History

Date Action Reason
February 2014 Revised Added LL (Lease) language.
February 2013 Revised Added rental to purchase language
August 2012 Revised Changed dollar amount from $300 to $500/ Added Exception for Breast Pumps
November 2010 Revised NU modifier information added for oxygen accessories
July 2010 Revised Title change to reflect DMEPOS
October 2009 Revised Added AU, AW, QE, QF and QG modifiers

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