Wednesday, May 12, 2010

DME billing modifier QF, QG, GK, KR & RR

DME MAC Jurisdiction C Modifier

QF -- PRESCRIBED AMOUNT OF OXYGEN EXCEEDS 4 LPM AND PORTABLE OXYGEN IS PRESCRIBED. These modifiers may only be used with stationary gaseous (E0424) or liquid (E0439) systems or with an oxygen concentrator (E1390, E1391). They must not be used with codes for portable systems or oxygen contents.


QG -- PRESCRIBED AMOUNT OF OXYGEN IS GREATER THAN 4 LITERS PER MINUTE (LPM).These modifiers may only be used with stationary gaseous (E0424) or liquid (E0439) systems or with an oxygen concentrator (E1390, E1391). They must not be used with codes for portable systems or oxygen contents.

QE -- PRESCRIBED AMOUNT OF OXYGEN IS LESS THAN 1 LITER PER MINUTE (LPM).This modifier may only be used with stationary gaseous (E0424) or liquid (E0439) systems or with an oxygen concentrator (E1390, E1391). They must not be used with codes for portable systems or oxygen contents


GK -- REASONABLE AND NECESSARY ITEM/SERVICE ASSOCIATED WITH A GA OR GZ MODIFIER (UPDATED 1/1/2008)


KR -- RENTAL ITEM, BILLING FOR PARTIAL MONTH.


RR -- RENTAL. (USE THIS 'R' MODIFIER WHEN DME IS TO BE RENTED)This modifier is used for DME items that are rented, and will be used for equipment in the following categories: Inexpensive or other Routinely purchased DME (IRP), Frequent or Substantial Servicing (FS), Certain customized items, Other Prosthetic and Orthotic Devices (P & O), Capped Rental Items (CR), Oxygen and Oxygen Equipment.

RP -- REPLACEMENT AND REPAIR. (DELETED EFFECTIVE 12/31/2008)RP MAY BE USED TO INDICATE REPLACEMENT OF DME, ORTHOTIC AND PROSTHETIC DEVICES, WHICH HAVE BEEN IN USE FOR SOMETIME.


RA -- REPLACEMENT OF A DME ITEM (EFFECTIVE 01/01/2009)Claims for replacement of DME items should include the RA modifer for dates of service on or after January 1, 2009.

RB -- REPLACEMENT OF A PART OF DME FURNISHED AS PART OF A REPAIR (EFFECTIVE 01/01/2009)


Rental and Purchase Modifiers

Some DME items are eligible for rental as well as for purchase. The codes representing these items are listed in Items Eligible for Rental or Purchase in the Attachments section below and must be reported with the appropriate rental or purchase modifier in order to be considered for reimbursement.

Some DME items are eligible for rental only. The codes representing these items are listed in Items Eligible for Rental Only in the Attachments section below and must be reported with the appropriate rental modifier in order to be considered for reimbursement.

Rental fees fr om a single vendor are payable up to either the purchase price of an item or a maximum number of rental months, whichever is less. These rental limits do not apply to oxygen equipment or to ventilators. Rental guidelines are explained further in the sections titled Monthly Rental and Daily Rental.

Rental Modifiers

The following modifiers indicate that an item has been rented:

 RR - Rental

 KH - Initial Claim, purchase or first month rental

 KI - Second or third monthly rental

 KJ - Capped rental months four to fourteen

 KR - Partial month

Purchase Modifiers

The following modifiers indicate that an item has been purchased:

 NU - New Equipment (use the NR modifier when DME which was new at the time of rental is subsequently purchased)

 UE - Used Equipment

 NR - New when rented

 KM - Replacement of facial prosthesis including new impression/moulage

 KN - Replacement of facial prosthesis using previous master model



Monthly Rental

Monthly rental of DME, Orthotics, or Prosthetics identified by the applicable code with a rental modifier RR and/or modifiers KH, KI, KJ, KR appended will be reimbursed once per Calendar month to the Same Specialty Physician, Hospital, Ambulatory Surgical Center or Other Health Care Professional. A Calendar Month is the period of duration from a day of one month to the corresponding day of the next month (please see Definitions) and is determined based on the “From” date reported on the claim. If a code is submitted with modifier RR and/or modifiers KH, KI, KJ, KR with units greater than 1, or multiple times during the same Calendar Month, Oxford will only reimburse one monthly rate per Calendar Month to the Same Specialty Physician Hospital, Ambulatory Surgical Center or Other Health Care Professional except where noted below.


Modifiers RT and LT

An additional rental rate will be allowed in the same Calendar Month for codes with a rental modifier when both modifiers RT and LT are submitted for the same HCPCS code on separate lines. Modifiers RT and LT may be used to report an item for the right or left side of the body. Use of these modifiers may convey that multiples of that item are being utilized.

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