CurrentCareSource GeorgiaPolicy MP-MM-1582

Durable Medical Equipment Repairs

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Governs medical necessity review, provider documentation, authorization, billing, and payment for durable medical equipment repairs and maintenance in applicable CareSource Marketplace states.

Policy Summary

PayerCareSource Georgia

PolicyDurable Medical Equipment Repairs

Policy CodePolicy MP-MM-1582

Change TypePeriodic reviewno material changes

Effective DateNovember 1, 2026

Last ReviewJul 29, 2026

Next Review DateNot specified

Key ActionSubmit medical necessity documentation before authorization for every DME repair.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

All repairsMedical necessity review

8 elementsDocumentation requirements

K0739Labor billing code

12 monthsRepair lookback

NUReplacement part modifier

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CurrentCareSource GeorgiaPolicy MP-MM-1582

Durable Medical Equipment Repairs

Customize your policy alerts

Sign up for CareSource Georgia Policy MP-MM-1582 alerts

Get alerted when Policy MP-MM-1582 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Governs medical necessity review, provider documentation, authorization, billing, and payment for durable medical equipment repairs and maintenance in applicable CareSource Marketplace states.

Policy Summary

PayerCareSource Georgia

PolicyDurable Medical Equipment Repairs

Policy CodePolicy MP-MM-1582

Change TypePeriodic reviewno material changes

Effective DateNovember 1, 2026

Last ReviewJul 29, 2026

Next Review DateNot specified

Key ActionSubmit medical necessity documentation before authorization for every DME repair.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

All repairsMedical necessity review

8 elementsDocumentation requirements

K0739Labor billing code

12 monthsRepair lookback

NUReplacement part modifier

DME Repair Coverage Criteria

DME Repair Medical Necessity and Documentation

DME repairs are covered when medically necessary to make the item or device serviceable and when all applicable review and documentation requirements are met.

ALL of the following

A review of medical necessity is required for every DME repair. If the DME item was not originally approved by CareSource, medical necessity must be established before the repair is authorized.
The repair, including replacement of essential accessories such as hoses, tubes, or mouthpieces, is necessary to make the item or device serviceable.
The provider must submit ALL of the following documentation
- Specification of the item, including manufacturer, model, and serial number, if applicable.
- Date the item was originally purchased or dispensed; if unknown, provide the approximate age of the item.
- Any warranty period and the type of warranty, including manufacturer or dealer warranty.
- Full description of the wear, damage, or malfunction.
- Full description of the proposed repair.
- Description, with dates, of previous repairs, both major and minor.
- Complete itemization of parts.
- Estimate of the labor time needed. Labor must be billed with K0739 in 15-minute increments; 4 units equal 60 minutes of labor.

Repair Versus Replacement Cost Effectiveness

During medical necessity review, CareSource evaluates whether repairing the existing equipment is more appropriate and cost-effective than replacing it.

ALL of the following apply during review

Providers should advise CareSource when, in the provider's professional opinion, replacement would be more cost-effective than repair.
CareSource may consider whether purchasing new equipment would be more cost-effective than continued repair. Replacement may involve equipment beyond its reasonable or useful life span or equipment that is irreparable, including the same or similar type of equipment.
Multiple repair requests within a short time span may suggest deliberate or malicious damage or destruction; in these cases, the repair may be denied.
Repair of an item is also not separately payable if, within the preceding 12 months, Medicaid paid for repair of a duplicate or conflicting item currently in the individual's possession.

No separate payment will be made for temporary replacement equipment, including loaner equipment provided while the individual's own equipment is being repaired.

No separate payment will be made for maintenance or repair of DME during a rental period.

No separate payment will be made for repair of an item that is no longer deemed medically necessary.

Billing and Coding Rules

DME repair laborHCPCS

K0739

Labor billed in 15-minute increments for DME repair labor.

Replacement part modifier instructionModifier

NU	Modifier to use for a replacement part treated as a new equipment purchase.
RB	Modifier that should not be used for a replacement part treated as a new equipment purchase.

Labor Billing Increment

Billing increment15 minutes per unit

Unit conversion4 units represent 60 minutes of labor

Applicable labor codeK0739

Duplicate or Conflicting Repair Lookback

Lookback periodPreceding 12 months

Applies toRepair of an item when Medicaid paid for repair of a duplicate or conflicting item currently in the individual’s possession

Payment rule

Provider Review and Payment Requirements

Prior Authorization

Medical Necessity Review Before Authorization

A medical necessity review is required for every DME repair before authorization. If CareSource did not originally approve the DME item, establish medical necessity before the repair is authorized.

Advise CareSource when, in the provider’s professional opinion, replacing the item would be more cost-effective than repairing it.
CareSource may consider whether purchasing new equipment is more cost-effective than continued repair.

Documentation Required

Equipment Identification and Condition

Identify the equipment and document its purchase or dispensing information, age, and warranty status.

Specify the manufacturer, model, and serial number, if applicable.
Provide the original purchase or dispensing date; if unknown, provide the approximate age.

Policy Background

Durable medical equipment (DME) serves a medical purpose, supports activities of daily living, withstands repeated use, and is primarily used in the home. Examples include wheelchairs, hospital beds, continuous positive airway pressure (CPAP) equipment, walkers, and oxygen tanks. DME is generally expected to last three years or more, but may require periodic maintenance, service, or repair to restore it to working order.

Key Definitions

Durable Medical Equipment (DME)

Repeated useEquipment that can withstand repeated use

Medical purposePrimarily and customarily used to serve a medical purpose

Use without illness or injuryNot useful to a person in the absence of illness or injury

Home useAppropriate for use in the home

Healthcare Common Procedure Coding System (HCPCS)

Code setA numeric and alphanumeric code set

Maintained and distributed byThe Centers for Medicare and Medicaid Services (CMS)

Medical Necessity for DME Repair

Coverage requires medical necessity review for all DME repairs.

Repair eligibility

The repair is necessary to make the DME item or device serviceable.
The DME item remains medically necessary.
If the DME item was not originally approved by CareSource, medical necessity is established before repair authorization.

Rental and Purchase Payment Rules

Equipment or service	Payment rule	Coverage
DME during rental	No separate payment is made for maintenance and repair during a rental period.	Not separately paid

Equipment or service	Payment rule	Coverage
Replacement parts	Treated as a new equipment purchase; use modifier NU instead of modifier RB.	Purchase rule

Required Documentation

Documentation Required

Document the item, age, and warranty

Identify the DME item and document its age and warranty status as part of the repair request.

Manufacturer, model, and serial number, if applicable
Original purchase or dispensing date, or approximate age
Warranty period and warranty type, including manufacturer or dealer warranty

Documentation Required

Describe the problem and proposed repair

Provide a full description of the equipment’s wear, damage, or malfunction and a full description of the requested repair.

Documentation Required

Provide repair history and parts detail

Submit dated descriptions of previous major and minor repairs together with a complete itemization of parts.

Non-Payable Repair Situations

The following are not separately paid: temporary replacement or loaner equipment provided while the member’s equipment is being repaired; repair when Medicaid paid within the preceding 12 months for repair of a duplicate or conflicting item currently in the member’s possession; repair of equipment that is no longer medically necessary; and maintenance or repair of DME during a rental period. Multiple repairs requested within a short time span may suggest deliberate or malicious damage or destruction and may be denied.