By Kim Turner, RN
When billing Medicare, the billing modifiers can be alphabetic, numeric or a combination of both, but will always be two digits for Medicare purposes. Some modifiers cause automated pricing changes, while others are used to convey information only. They are not required on all HCPCS codes; however, if required and not submitted, the claim will deny as unprocessable.
Payment may be made for repair, maintenance, and replacement of medically required DME, including equipment which had been in use before the user enrolled in Medicare Part B of the program.
The repair and maintenance of oxygen equipment is not reimbursed separately but is included in the oxygen rental payment and must be provided by the supplier after oxygen rental payments end for the two years remaining in the equipment's useful lifetime.
- Repairs
- Repairs to equipment which a beneficiary owns are covered when necessary to
make the equipment serviceable.
- Modifier RB - The RB modifier is used for replacement parts furnished in order to repair beneficiary-owned DMEPOS.
- When filing Medicare a claim for repairs, include the HCPCS code and date of purchase of the item being repaired (if the HCPCS code is not available, include the manufacturer’s name, product name, and model number of the equipment), the manufacturer’s name, product name, model number, and supplier price list amount of the repair item provided, and the justification of the repair.
- Replacement
- Equipment which the beneficiary owns or is a capped rental item may be
replaced in cases of loss or irreparable damage. Irreparable damage refers to a
specific accident or to a natural disaster, e.g., fire, flood, etc.
- Modifier RA - The RA modifier is described as replacement of a DME item, due to loss, irreparable damage, or when the item has been stolen. Use of the RA modifier implies that the entire DMEPOS item (base equipment) is being replaced. If a specific part is being replaced, but not the base equipment, the service is considered a repair and the RB modifier should be used on the claim (see above).
- The following documentation is required when filing a Medicare claim for replacement: 1) Reason for replacement 2) New CMN (if required)
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