Our Reimbursement Experts Ronda and Dan Work Their Modifier Magic

Posted on in Billing/Reimbursement

Recently VGM’s reimbursement experts, Ronda Buhrmester and Dan Fedor, conducted a webinar called “Modifier Magic,” where they removed much of the mystery surrounding the use of modifiers when billing Medicare claims.

During their Q&A session, Ronda and Dan fielded several questions from attendees. They selected the following participant questions – and answers – to share with Connect readers.

Q: What modifiers are needed for a reasonable, useful lifetime (RUL) for oxygen therapy to start a new 36-month rental?

A: Oxygen therapy is the only policy that requires the RA modifier in order to start a new, 36-month rental. The RA modifier is required on the first-month rental ONLY in addition to the RR (example: E1390 RR RA) along with a narrative in the note section on the claim (RUL and original DOS).

Q: What modifiers are needed for a claim being submitted as non-assigned?

A: There are no special modifiers that are specific for non-assigned claims. Use the modifiers that are applicable for the equipment and per policy.

Q: When I am repairing patient-owned equipment and the patient needs a temporary replacement equipment (AKA loaner) while their equipment is being repaired, what modifiers do I need?

A: The temporary replacement HCPCS code K0462 does not require any modifiers but does require a narrative in the note (NTE) section with the claim. The supplier is entitled to one unit, which equals one month reimbursement regardless of how long the repair may take (one week, two months, etc.); the supplier will receive one month reimbursement.

  • A narrative description of the equipment being used as a temporary replacement, including the manufacturer, brand name and model name/number of the temporary replacement item.
  • A statement of why the replacement is needed (e.g., sent MFR for repairs).
  • Claims must include the HCPCS code and manufacturer name, brand name, and model name or number of the beneficiary-owned piece of equipment and the date of purchase of the equipment.
  • You must abbreviate to fit it in to extra narrative.

It’s best to submit the claim with the K0462 and repairs together on one claim in order to avoid any issues.

Q: Can I use the KU modifier on repairs such as motors, joystick, batteries, etc.? And, is the KU only used when the beneficiary resides in a competitive bid area?

A: The KU modifier should be used on any affected accessory when used on a Group 3 power wheelchair base (initial or as a repair) regardless of where the beneficiary resides. The KU enables the system to pull the allowable from the unadjusted fee schedule that is not affected by competitive bidding, resulting in a higher allowable. For example, motors (E2370) being replaced on a Group 3 base with the KU modifier will allow $778.90 EACH; without the KU modifier, the allowable would be $509.70 EACH (non-rural fee). That's a difference of $269.20 per motor and, with two motors being replaced, it's $538.40 additional reimbursement by using the KU. So please, remember to use the KU on affected accessories used on Group 3 power bases for both initial and repair. 

Q: Which DME category is the BP modifier used?

A: The BP modifier indicates that the beneficiary elected to purchase the capped rental item in the first month. This purchase option is available for complex rehab power wheelchair bases (K0835-K0864) and the capped renal accessories used on those bases such as tilt (E1002), tilt and recline (E1007), power center mount elevating leg rests (E1012), etc. Providers must have a signed and dated purchase option letter on file before submitting a claim with the BP modifier. The BP would not be applicable on any other capped rental items, and it is NOT used on IRP items such as cushions, backs, batteries, etc. 

If you have questions about modifiers or anything reimbursement related, please reach out to our reimbursement team.

Ronda Buhrmester
[email protected]

Dan Fedor
[email protected]