CurrentBlue Cross Blue Shield - WisconsinPolicy G-06053

DME Modifiers for New, Rented, and Used Equipment

Defines reimbursement billing modifiers (NU, UE, RR) for durable medical equipment, prosthetics, and orthotics for Anthem Medicare Advantage members and outlines reimbursement basis and potential denials for missing modifiers.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyDME Modifiers for New, Rented, and Used Equipment

Policy CodePolicy G-06053

Change TypeTemplate update (administrative)

Effective Date09/14/2020

Next Review Date

Key ActionBill equipment with the appropriate reimbursement modifier in the primary/first modifier field; claims without the modifier may be denied.

SourceLink

POLICY UPDATE CHANGES

Updated policy template during review on 06/09/2023.

3reimbursement modifiers listed (NU, UE, RR)

4equipment types referenced

1policy number

2dates shown

DME Modifier Coverage Criteria

Reimbursement and billing criteria for new, rented, or used equipment:

Equipment billed with an appropriate reimbursement modifier in the primary/first modifier field to determine reimbursement

Valid reimbursement modifiers are: NU (new equipment), UE (purchase of used equipment), and RR (rented equipment)

These modifiers apply to durable medical equipment (DME), prosthetics, and orthotics

These modifiers are inappropriate for supplies unless required by State or CMS requirements

Reimbursement will be based on the applicable fee schedule or contracted/negotiated rate when a valid modifier is present

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyDME Modifiers for New, Rented, and Used Equipment

Policy CodePolicy G-06053

Change TypeTemplate update (administrative)

Effective Date09/14/2020

Next Review Date

Key ActionBill equipment with the appropriate reimbursement modifier in the primary/first modifier field; claims without the modifier may be denied.

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 Requirements and Denial Risk

Billing Rule

Modifier billing requirement — Bill equipment with appropriate reimbursement modifier in primary/first modifier field

Bill equipment with the appropriate reimbursement modifier in the primary/first modifier field. The following modifiers identify equipment status and must be used to determine reimbursement: NU = new equipment; UE = purchase of used equipment; RR = rented equipment. These modifiers apply to durable medical equipment (DME), prosthetics, and orthotics. They are not appropriate for supplies unless required by State or CMS rules. Reimbursement will be based on the applicable fee schedule or contracted/negotiated rate when a valid modifier is submitted. Claims for equipment submitted without the appropriate reimbursement modifier may be denied.

Modifier NU: new equipment
Modifier UE: purchase of used equipment
Modifier RR: rented equipment
Modifiers must be billed in the primary/first modifier field
Applies to DME, prosthetics, and orthotics; generally not for supplies unless State/CMS requires

Key Device Definitions

Durable Medical Equipment (DME)

DefinitionItems primarily and customarily used to serve a medical purpose, not for convenience or comfort; able to withstand repeated use; generally not useful without illness or injury; appropriate for home use.

ScopeIncludes items for which reimbursement modifiers (NU, UE, RR) may be appended to identify new, used, or rented equipment.

ExclusionsSupplies are generally not appropriate for these modifiers unless required by State or CMS.

Prosthetic Device

DefinitionAn 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.

Reimbursement noteProsthetic devices are among the item types for which reimbursement modifiers (NU, UE, RR) are appropriate.

ContextCoverage and reimbursement subject to applicable fee schedule or contracted/negotiated rate when valid modifier is present.

Orthotic Device

DefinitionA 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.

ClassificationOrthotic devices are included with DME and prosthetics for purposes of applying reimbursement modifiers (NU, UE, RR).

Use settingGenerally appropriate for use in the home when meeting DME criteria and medical necessity requirements.

OpenPayer

DME Modifiers for New, Rented, and Used Equipment

DME Modifier Coverage Criteria

Reimbursement Modifiers and Billing Placement

Billing Requirements and Denial Risk

Key Device Definitions

NU	new equipment
UE	purchase of used equipment
RR	rented equipment