Today we would like to talk about the complexity of reimbursement flow experienced by those who only render equipment to their patients. There are several myths about DME billing. Let us debunk each of them.
DME services need to be billed on a distinctive claim form
No, equipment is billed on the same two claim forms that are used for “regular” services – CMS-1500 (outpatient) and CMS-1450 (inpatient). Contrary to Workers’ Compensation, there is no need to use a separate claim form.
Equipment can only be reported using HCPCS codes
Yes, there are no CPT codes that can be used for DME billing. Only the following alphanumeric Medicare-approved HCPCS codes can be used to bill equipment:
• A9150-A9300 - Other Supplies and Devices
• E1500-E1699 - Artificial Kidney Machines and Accessories
• E0830-E0900 - Traction Equipment
• E1352-E1406 - Additional Oxygen Related Equipment
• A4730-A4932 - Dialysis Supplies
• E0700-E0710 - Safety Equipment
• K0900-K1027 - Other DME
• E0550-E0585 - Humidifiers/Compressors/Nebulizers
• A7000-A7048 - Respiratory Supplies
• E0776-E0791 - Infusion Supplies
There is no need to use modifiers for medical supplies
No, DME services require to be billed with specific modifiers when there is a need to indicate an additional level of detail and emphasize the medical necessity of billed service. The following procedure modifiers are the most popular and reimbursable for DME services:
• RR - Rental
• NU - Purchase of new equipment
• UE - Purchase of used equipment
• KH – Initial claim, first-month rental
• KI – Second and third capped rental months
• KJ – Fourth to 13th capped rental months
• RA – Replacement of equipment due to an unrepairable damage
• RT – Right body part
• LT – Left body part
• KX – the additional medical necessity of services
Durable medical supplies are not covered by most commercial insurance payers
This is not true. Coverage of a certain procedure strictly depends on an individual patient’s insurance plan.
Claim collection process is different for DME claims.
No, since the same claim forms and ways of submissions are implemented to DME services as for “regular” claims, there is no difference in claim collection process between the two.
No matter what your misconceptions might be, We Can Help you bill your DME services quickly and efficiently. Contact us!
