CurrentColorado Rocky Mountain Health PlansPolicy 2026R0109C

Reimbursement for DME rental and purchase on CMS-1500

Policy governs UnitedHealthcare reimbursement rules for rental and purchase of durable medical equipment, prosthetics and orthotics billed on the CMS-1500 form; applies to Commercial and Individual Exchange products and all network and non-network providers/vendors.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyReimbursement for DME rental and purchase on CMS-1500

Policy CodePolicy 2026R0109C

Change TypeAttachment updates (non-material)

Effective Date

Next Review Date

Key ActionSubmit claims on the CMS-1500 (or electronic equivalent) and report monthly rentals as a single claim line per calendar month using appropriate modifiers.

SourceLink

POLICY UPDATE CHANGES

Attachments Section: Items Eligible for Rental or Purchase list was updated (4/19/2026).

Attachments Section: Items Eligible for Rental or Purchase list was updated (3/29/2026).

once/momonthly rental reimbursed frequency

every 6 momaintenance/service interval

A9900,A9901,L9900codes not reimbursable

E0935example daily rental item

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.

Rental and Purchase Coverage Criteria

Rental and Purchase Criteria

Reimbursement criteria for DME, prosthetics, and orthotics billed on the CMS-1500 form.

Total reimbursement from a single vendor for a single HCPCS code modified with RR and/or NU is limited to either the purchase price or a maximum number of rental months, whichever is less; rental limits do not apply to oxygen equipment or ventilators.

Monthly rental of DME, Orthotics, or Prosthetics reported with an applicable rental modifier (RR, KH, KI, KJ, KR) will be reimbursed once per Calendar Month to the Same Specialty Physician or Other Qualified Health Care Professional; Calendar Month is determined by the 'From' date on the claim.

If a code with a rental modifier is submitted multiple times or with units greater than 1 during the same Calendar Month, UnitedHealthcare will reimburse only one monthly rate per Calendar Month to the Same Specialty Physician or Other Qualified Health Care Professional, except as specifically allowed (see RT/LT, second ventilator, codes with extension/flexion/supination/pronation or 'each' in description, and daily rental exceptions).

Exceptions allowing additional monthly rental rates

An additional rental rate will be allowed in the same Calendar Month when both modifiers RT and LT are submitted for the same HCPCS code on separate lines (right and left side).
One additional rental rate will be allowed in the same Calendar Month for a second ventilator reported with a rental modifier plus modifier KX appended to HCPCS code E0465, E0466 or E0467.
Up to two rental rates will be allowed in the same Calendar Month for codes that include 'extension/flexion,' 'supination/pronation' or 'each' in the description; when RT and LT are used, one unit per side may be considered for separate reimbursement (total up to two).
Items listed in the Daily Rental section (for example, HCPCS code E0935) are reimbursed on a daily basis consistent with CMS guidelines and are exceptions to the monthly rental rule.

Monthly rental must be reported on CMS-1500 (or electronic equivalent) with the appropriate HCPCS code and rental modifier, one unit per Calendar Month time span, entering the rental initiation date in the 'From' field and the end date in the 'To' field; multiple months must be reported on separate claim lines with distinct From dates as shown in the policy example.

When a code is reported with modifier KR indicating partial-month use (days), UnitedHealthcare still pays a single monthly rate and does not prorate payment for partial-month usage (except for items in the Daily Rental section).

Repair services (e.g., K0739, K0740, K0462) are included in the rental payment and are not separately reimbursable during the rental period; repair may be allowed for purchased (patient-owned) DME.

DME coverage criteria

Coverage and billing rules for durable medical equipment, orthotics and prosthetics.

Maintenance and Service: UnitedHealthcare allows reimbursement for maintenance and service once every six months to the Same Specialty Physician or Other Qualified Health Care Professional when billed with the appropriate HCPCS code appended with modifier MS on a separate line; maintenance/service does not apply to Orthotics or Prosthetics.

Delivery, set-up and supplies are included in the payment rates associated with a DME, Orthotic, or Prosthetic item and are not reimbursable when submitted alone or with another service; therefore codes A9900, A9901 and L9900 will not be separately reimbursed.

Place of Service: Reimbursement is limited to devices intended for use in the patient’s home. The POS codes that qualify as the patient’s home include: 01, 04, 09, 12, 13, 14, 16, 31, 32, 33, 54, 55, 56, and 65; devices intended for use in a POS other than the patient’s home are not reimbursable.

Initial purchase: Certain supplies are included in the initial purchase or rental (for example, brakes provided with walker E0141 are included and may not be billed separately).

HCPCS, Modifiers, and Coding Rules

Provider Billing and Reporting Requirements

Billing Rule

Application and Scope

This reimbursement policy applies to services reported using the CMS-1500 (or electronic equivalent). It applies to all products and to all network and non‑network physicians and other qualified health care professionals, including non‑network authorized and percent‑of‑charge contract providers. For purposes of this policy, "Same Specialty Physician or Other Qualified Health Care Professional" means providers of the same group and specialty reporting the same Federal Tax Identification Number (TIN).

Billing Rule

Reporting Monthly Rental and KR modifier handling

Monthly rentals must be reported on a single claim line per Calendar Month. Enter the rental initiation date in the From field and the month's end date in the To field for that month. Do not report multiple months' rental on the same claim line. If two claims from the Same Specialty Physician or Other Qualified Health Care Professional show From dates in the same Calendar Month for the same item, only one claim will be allowed and the duplicate will not be covered. UnitedHealthcare reimburses one full Calendar Month rate per month regardless of the number of days used in that month; modifier KR may be used to indicate partial‑month use but does not change the single monthly payment (except for items listed under Daily Rental).

Key Definitions

Same Specialty Physician/Qualified Professional

DefinitionPhysicians and/or Other Qualified Health Care Professionals of the same group and same specialty reporting the same Federal Tax Identification number (TIN)

IncludesIncludes DME, Prosthetic and Orthotic vendors when they are part of the same group and specialty reporting the same TIN

PurposeUsed to determine single-provider reimbursement limits for monthly rental and related billing rules

Calendar Month definition

Calendar Month periodThe period from a day of one month to the corresponding day of the next month; determined based on the 'From' date reported on the claim

Determines reimbursementReimbursement for monthly rental is calculated once per Calendar Month using the From date to define the month span

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyReimbursement for DME rental and purchase on CMS-1500

Policy CodePolicy 2026R0109C

Change TypeAttachment updates (non-material)

Effective Date

Next Review Date

Key ActionSubmit claims on the CMS-1500 (or electronic equivalent) and report monthly rentals as a single claim line per calendar month using appropriate modifiers.

SourceLink

On This Page

Rental Billing: Rental is reimbursed once per Calendar Month; report monthly rental as a single claim line with one unit and the Calendar Month date span (From/To). Multiple months must be reported on separate claim lines with different From dates; if two claims have From dates in the same month for the same item from the Same Specialty Physician or Other Qualified Health Care Professional, only one claim will be allowed for that month.

KR modifier handling: When modifier KR is used to indicate days of use within a Calendar Month, UnitedHealthcare still pays a full Calendar Month rental rate and does not prorate to a daily amount (except for items identified in the Daily Rental section).

Billing frequency and reporting: Monthly rental should follow NUCC/NUBC guidelines and be submitted on CMS-1500 (electronic equivalent) with one unit per month span; see policy Q&A and Reporting Monthly Rental example for correct From/To reporting.

Report monthly rental as one unit with From = rental start date and To = end date of that Calendar Month
Do not place multiple months on one claim line; use separate lines each with different Calendar Month spans
If two claims for same item from same TIN have From dates in same month, only one will be allowed
Modifier KR may indicate days used in month but UnitedHealthcare pays one full monthly rate

Billing Rule

Maintenance/Service billing (modifier MS)

Maintenance and service fees may be reimbursed once every six months to the Same Specialty Physician or Other Qualified Health Care Professional. The appropriate HCPCS code must be appended with modifier MS and the MS‑appended code must be reported on a separate line in order to be considered for separate reimbursement from the rental or purchase of the equipment. Maintenance and service includes routine maintenance, re‑education, compliance with recalls, necessary supplies per agreement, back‑up equipment, and emergency availability/replacement while an item is out for repair. Maintenance/service does not apply to Orthotics or Prosthetics.

Append modifier MS to the appropriate HCPCS code to identify maintenance/service
Report the MS line on a separate claim line for separate reimbursement consideration
Maintenance/service may be billed once every six months to Same Specialty Physician or Other Qualified Health Care Professional
Maintenance/service does NOT apply to Orthotics or Prosthetics

Denial Risk

Non-reimbursable delivery/set-up codes

Delivery, set‑up and supplies are included in the payment rates associated with DME, Orthotic, or Prosthetic items and are not separately reimbursable when submitted alone or with another service. Codes for delivery/set‑up or miscellaneous supplies will not be paid separately.

Do not bill A9900, A9901, or L9900 for separate reimbursement — these codes will not be paid when submitted alone or with another service
Include delivery/set‑up and routine supplies in the item charge; they are considered part of the payment for the DME/Orthotic/Prosthetic

Billing implicationClaims with From dates in the same Calendar Month for the same item/provider will only be reimbursed once

Durable Medical Equipment (DME) definition

DME definitionMedical equipment which: can withstand repeated use; is not disposable; is used to serve a medical purpose; is generally not useful in the absence of sickness or injury; and is appropriate for use in the home.

Examples/ScopePolicy governs rental and/or purchase of certain DME items and the provisions apply to Same Specialty Physicians and Other Qualified Health Care Professionals, including vendors

Relation to POSReimbursement is limited to devices intended for use in the patient's home (see policy for permitted place-of-service codes)

Orthotic definition

Orthotic definitionAn external appliance such as a brace or splint that prevents or assists movement of the spine or limbs; a brace may support a weak or deformed body part or restrict/eliminate motion in a diseased or injured part of the body.

Use caseIncluded in policy provisions for rental/purchase and reimbursement when billed on CMS-1500

Billing noteCertain supplies included with initial purchase/rental (examples provided in policy attachments) may not be billed separately

Prosthetic definition

Prosthetic definitionA device that replaces all or part of an external body organ or all or part of the function of a permanently inoperative or malfunctioning external body organ.

ApplicationCovered under the same rental/purchase reimbursement rules when billed on CMS-1500; see Items Eligible lists for specific codes

Purchase vs rentalDevices may be eligible for rental, purchase, or rental-only as specified in the policy attachments

Same Specialty Physician or Other Qualified Health Care Professional definition

DefinitionPhysicians and/or Other Qualified Health Care Professionals of the same group and same specialty reporting the same Federal Tax Identification number (TIN)

Includes vendorsIncludes DME, Prosthetic and Orthotic vendors when they meet the same group/specialty and TIN criteria

RelevanceDetermines which provider/vendor is eligible for single monthly reimbursement and other policy-specific limits