Know your DME Modifiers

1. Know your DME Modifiers Medical Billers and Coders

2. Equipment that provides therapeutic benefits to a patient and is primarily for long-term and home use is termed as Durable Medical Equipment (DME). Due to a wide variety of models for DME, Centers for Medicare and Medicaid Services (CMS) instituted the Healthcare Common Procedure Coding System (HCPCS) and modifiers which correspond to the parameters policy and LCD and make the HCPCS code valid before claim processing.

3. Modifiers are divided into several categories: • Routinely purchased Pricing Modifiers • Capped Rental Items and modifiers • Modifiers for Oxygen and the Corresponding equipment • Functional Modifiers for Prosthetics and Orthotics • Osteogenesis Stimulators • Tape (A4450, A4452) • Drug Formulations (pedorthics.org) • Anatomic Modifiers • Up-gradation/Prescription requirement • Added modifiers

4. Routinely purchased Pricing Modifiers:

5. Capped Rental Items and modifiers: One can use RR in this category except for wheelchairs where the patient is allowed the option to buy one. Others are:

6. Other Categories:

7. Modifiers for Oxygen and the Corresponding equipment:

8. Functional Modifiers for Prosthetics and Orthotics: Osteogenesis Stimulators:

9. Tape (A4450, A4452): Drug Formulations (pedorthics.org):

10. Anatomic Modifiers:

11. Up-gradation/Prescription requirement:

12. Added modifiers: As mentioned above, DME modifiers are two-character alpha or numeric codes that are added to the end of HCPCS codes to elucidate the benefits when billed. Adding these augments the reimbursement process.

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