CurrentAnthemPolicy G-06053

DME Modifiers for New, Rented, and Used Equipment

Governs billing and reimbursement rules for durable medical equipment (DME), prosthetics, and orthotics when reported as new, rented, or used for Anthem Medicare Advantage members; affects providers submitting claims to Anthem.

Policy Summary

PayerAnthem

PolicyDME Modifiers for New, Rented, and Used Equipment

Policy CodePolicy G-06053

Change TypeNo material change

Effective DateSep 14, 2020

Next Review Date

Key ActionAppend the appropriate reimbursement modifier (NU, RR, UE) in the primary/first modifier field for DME, prosthetics, and orthotics to determine reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3reimbursement modifiers listed (NU, RR, UE)

fee schedulereimbursement method

Claims may be denieddenial risk

06/09/2023last review

Reimbursement Rules Based on Modifiers

Modifier-based reimbursement criteria

Reimbursement allowed only when specific modifier rules are followed; describes which modifiers apply, placement requirements, appropriateness, and reimbursement basis.

Reimbursement allowed for new, rented, or used equipment when billed with the appropriate modifier.

Applicable modifiers: NU (new equipment), RR (rented equipment), UE (purchase of used equipment).

Modifiers must be billed in the primary or first modifier field to determine appropriate reimbursement.

These modifiers are appropriate for durable medical equipment (DME), prosthetics, and orthotics.

Modifiers NU, RR, UE are inappropriate for supplies unless required under State or CMS guidelines; claims for supplies appended with these modifiers may be denied.

Policy Summary

PayerAnthem

PolicyDME Modifiers for New, Rented, and Used Equipment

Policy CodePolicy G-06053

Change TypeNo material change

Effective DateSep 14, 2020

Next Review Date

Key ActionAppend the appropriate reimbursement modifier (NU, RR, UE) in the primary/first modifier field for DME, prosthetics, and orthotics to determine reimbursement.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Billing, Authorization, and Submission Requirements

Billing Rule

Billing and authorization requirements

You must follow proper billing and submission guidelines. Use industry-standard CPT, HCPCS, and/or revenue codes on all claim submissions and ensure coding is supported in the medical record. Services must meet authorization and medical necessity requirements. Failure to follow coding/billing or authorization guidelines may result in claim denial, recovery/recoupment of payment, or adjusted reimbursement.

Use Current Procedure Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and revenue codes as appropriate.
Follow authorization and medical necessity guidelines applicable to the procedure, diagnosis, and member's state of residence.
Noncompliance may lead to claim rejection/denial, payment recovery/recoupment, or reimbursement adjustment.

Billing Rule

Modifier submission requirement

Append the appropriate reimbursement modifier in the primary/first modifier field to identify equipment status for DME, prosthetics, and orthotics. Anthem reimburses new, rented, or used equipment only when the valid modifier is present unless otherwise required by provider, state, federal, or CMS contracts/requirements.

Modifier NU — new equipment (use in primary/first modifier field)
Modifier RR — rented equipment (use in primary/first modifier field)
Modifier UE — purchase of used equipment (use in primary/first modifier field)
Modifiers NU, RR, UE are considered reimbursement modifiers and are inappropriate for supplies unless required by State or CMS guidelines; claims for supplies with these modifiers may be denied.
Claims submitted without the appropriate reimbursement modifier may be denied; reimbursement is based on the applicable fee schedule or contracted/negotiated rate when a valid modifier is present.

Key Terms

Durable Medical Equipment (DME)

DefinitionItems primarily used to serve a medical purpose; can withstand repeated use; generally not useful without illness or injury; appropriate for use in the home; prescribed by a licensed physician/practitioner.

SettingAppropriate for use in the home

Prescriber requirementMust be prescribed by a licensed physician/practitioner

Functional criteriaPrimarily and customarily used to serve a medical purpose rather than convenience or comfort

Prosthetic Device

DefinitionAn artificial structural and functional replacement of a limb/appendage or internal organ, or replacement of all or part of the function of a permanently inoperative or malfunctioning internal body organ.

ScopeIncludes replacements of limb/appendage or internal organs and replacement of organ function

PermanenceUsed when an internal body organ is permanently inoperative or malfunctioning

Orthotic Device

DefinitionA brace with rigid metal or plastic stays applied to the body for support or immobilization, to correct or prevent deformity, or to assist or restore function.

MaterialsTypically includes rigid metal or plastic stays

FunctionsSupport, immobilization, deformity correction/prevention, or assistance/restoration of function

OpenPayer

DME Modifiers for New, Rented, and Used Equipment

Reimbursement Rules Based on Modifiers

Modifiers and Coding Requirements

Billing, Authorization, and Submission Requirements

Key Terms

NU	new equipment
RR	rented equipment
UE	purchase of used equipment