Debunking myths about Durable Medical Equipment billing

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!

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