CurrentAnthemPolicy N/A

DME Modifiers for New, Rented and Used Equipment

Defines reimbursement stance and billing requirements for durable medical equipment, prosthetics and orthotics when billed with modifiers indicating new or rented equipment; applies to claims for BadgerCare Plus members and to providers submitting claims to Anthem.

Policy Summary

PayerAnthem

PolicyDME Modifiers for New, Rented and Used Equipment

Policy CodePolicy N/A

Change TypeClarifiedtemplate updated (biennial review)

Effective DateMar 14, 2016

Next Review DateN/A

Key ActionUse industry standard, compliant codes and ensure services meet authorization and medical necessity; claims lacking appropriate coding or billing may be rejected, denied, or subject to recovery.

SourceLink

POLICY UPDATE CHANGES

Policy language was updated and the template was updated during a biennial review.

2reimbursement modifiers specified (NU, RR)

1modifier explicitly not reimbursed (UE)

03/14/16effective date

10/26/18committee approval / biennial review

Reimbursement Requirements

Reimbursement Criteria

Anthem allows reimbursement when valid modifiers identify new or rented equipment and billing, authorization and medical necessity requirements are met.

ALL of the following

The claim is submitted with an industry standard, compliant code (CPT, HCPCS and/or revenue code) and the billed code(s) are fully supported in the medical record and/or office notes.
The service meets authorization and medical necessity guidelines appropriate to the procedure, diagnosis and the member's state of residence.
ALL of the following
- ONE of
  - Modifier NU — new equipment

Policy Summary

PayerAnthem

PolicyDME Modifiers for New, Rented and Used Equipment

Policy CodePolicy N/A

Change TypeClarifiedtemplate updated (biennial review)

Effective DateMar 14, 2016

Next Review DateN/A

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.

Modifiers and Positioning

Reimbursement ModifiersModifierCovered

NU	Modifier for new equipment
RR	Modifier for rented equipment
UE	Modifier for used equipment (Anthem does not reimburse DME appended with UE)

Modifier position requirement — NU or RR must be billed in the primary or first modifier field to determine reimbursement.

RequirementModifiers NU or RR must be billed in the primary or first modifier field to determine appropriate reimbursement

Applicable ModifiersNU (new equipment); RR (rented equipment)

ScopeApplies to Durable Medical Equipment (DME), prosthetics, and orthotics

ConsequenceClaims submitted without the appropriate reimbursement modifier may be denied

Billing, Authorization, and Documentation Requirements

Prior Authorization

Prior Authorization, Coding, and Billing Requirements

Providers must use industry-standard CPT, HCPCS and/or revenue codes on all claim submissions and ensure billed codes are fully supported in the medical record and/or office notes. Anthem requires use of specific DME reimbursement modifiers in the primary or first modifier field to determine appropriate payment: Modifier NU for new equipment and Modifier RR for rented equipment. Claims for supplies generally should not be appended with NU or RR unless required by State or CMS guidelines; such claims may be denied. Anthem does not reimburse DME appended with modifier UE. Failure to follow proper coding/billing guidelines, prior authorization and medical necessity requirements may result in claim rejection or denial and potential recovery/recoupment of payments. Anthem reimbursement is subject to applicable fee schedules or contracted rates and may be superseded by provider, state, federal or CMS mandates.

Use industry-standard CPT/HCPCS/revenue codes on all claim submissions.
Billed codes must be fully supported in the medical record and/or office notes.
Prior authorization and medical necessity requirements must be met where applicable.
Bill Modifier NU (new equipment) or Modifier RR (rented equipment) in the primary/first modifier field for DME, prosthetics and orthotics to receive appropriate reimbursement.
Do not append Modifier NU or RR to supplies unless required by State or CMS guidelines — such claims may be denied.
Anthem does not reimburse DME appended with modifier UE.
Claims submitted without the appropriate reimbursement modifier may be denied; Anthem may reject/deny claims or recover payments if coding/billing guidelines are not followed.
Reimbursement is based on the applicable fee schedule or contracted/negotiated rate and may be subject to overrides by contractual or regulatory mandates.

Key Definitions

Durable Medical Equipment (DME)

DefinitionDurable Medical Equipment (DME): Items primarily and customarily used to serve a medical purpose; can withstand repeated use; generally not useful to a person without an illness or injury; appropriate for use in the home; prescribed by a licensed physician/practitioner.

Use CasesIncludes equipment where NU or RR modifiers are appropriate for reimbursement

Reimbursement NoteReimbursement based on applicable fee schedule or contracted/negotiated rate when valid modifier identifies new or rented equipment

Prosthetic Device

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

Relation to ModifiersModifiers NU or RR are appropriate for prosthetic devices when indicating new or rented items

Reimbursement NoteClaims for prosthetic devices with a valid modifier will be reimbursed per fee schedule or contracted rate

Orthotic Device

DefinitionOrthotic Device: A brace with rigid metal or plastic stays applied to the body for support or immobilization of a body part to correct or prevent deformity, or to assist or restore function.

Relation to ModifiersModifiers NU or RR are appropriate for orthotic devices when indicating new or rented items

Claims GuidanceClaims for orthotic devices must include the appropriate reimbursement modifier (NU or RR) in the first modifier field or may be denied