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Specialty billing

DME billing services for durable medical equipment suppliers

DME billing is claiming the equipment and supplies a supplier delivers, such as CPAP machines, oxygen, wheelchairs and braces, with HCPCS codes, modifiers for purchase or rental, and the order and delivery records payers check.

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DME

A capped rental, month by month

  1. Month 1KH
  2. Months 2–3KI
  3. Months 4–13KJ
  4. After 13owned
RR marks a rental; the patient owns the item after 13 continuous months.

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Follow a capped rental

Each month of a capped rental carries its own modifier, until the patient owns the item.

A capped rental, month by month

Medicare

Pick the rental month the claim is for.

Owned

Month 1

  • RR
  • KH

RR marks a rental; KH is the first month, KI the second and third, and KJ months four to thirteen.

Why is DME billing hard?

  • Every item is a HCPCS code

    Equipment and supplies are billed with HCPCS Level II codes: E codes for most equipment, A codes for supplies, L codes for orthotics and prosthetics. Medicare claims go to the DME contractor for the patient’s region, not the usual Medicare contractor.

  • Purchase or rental, month by month

    Modifiers say how an item is supplied: NU for new equipment bought, UE for used, RR for rental. Capped rentals add KH, KI or KJ for the rental month, and the patient owns the item after 13 continuous months.

  • Records before the claim

    Medicare needs a standard written order before the claim is sent, and for some items a face-to-face visit and a written order before delivery. Proof of delivery has to be on file for every item.

  • The forms went, the information didn’t

    Medicare stopped using certificates of medical necessity (CMNs) and DME information forms (DIFs) for dates of service from January 1, 2023, but what they recorded still has to be in the medical record, and the KX modifier says an item’s coverage criteria are met.

  • Same or similar equipment

    Medicare denies an item when the patient already has the same or similar equipment within its reasonable useful lifetime, usually five years, and some items need prior authorization.

What Beeline handles for DME suppliers

Further reading

DME billing questions

What do the NU, RR and UE modifiers mean?
They say how a DME item was supplied: NU is new equipment bought by the patient, UE is used equipment bought, and RR is a rental. Medicare requires one of them on claim lines for equipment that can be bought or rented.
What is a capped rental?
Equipment Medicare pays for as a monthly rental for up to 13 continuous months, after which the patient owns it, such as hospital beds and many wheelchairs. Its claims carry the RR modifier with KH for the first month, KI for the second and third, and KJ for months four to thirteen.
What is the KX modifier on a DME claim?
It tells the payer that the coverage criteria in the item’s policy are met and documented in the record. Medicare requires it on items whose policies call for it, and denies those claims without it.
Does Medicare still use certificates of medical necessity?
No. For dates of service from January 1, 2023, Medicare no longer requires CMNs or DME information forms. The information they held, such as an oxygen patient’s test results, still has to be in the medical record, and other payers set their own documentation rules.

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