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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyHealthy Blue Louisiana DME Policy Update | OpenPay…
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    CurrentHealthy Blue LouisianaPolicy G-06053

    DME Modifiers for New, Rented, and Used Equipment

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    This policy governs reimbursement modifier requirements for new, rented, and used durable medical equipment, prosthetics, and orthotics. It applies to provider claim submissions and specifies when modifier-based reimbursement is allowed or denied.

    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyDME Modifiers for New, Rented, and Used Equipment
    Policy CodePolicy G-06053
    Change TypeNo material change
    Effective DateMar 26, 2026
    Last ReviewMar 26, 2026
    Next Review DateN/A
    Key ActionAppend modifier NU for new equipment or modifier RR for rented equipment, and place it in the primary or first modifier field.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2Eligible equipment statuses
    1Ineligible equipment status
    3Modifiers addressed
    1stRequired modifier position

    Equipment Eligibility and Reimbursement Conditions

    Eligible new or rented equipment

    Equipment reimbursement depends on the equipment status, applicable modifier, modifier placement, and equipment category.

    ALL of the following

    • Item is durable medical equipment, a prosthetic device, or an orthotic device.
    • Claim includes the appropriate reimbursement modifier in the primary or first modifier field.
    • If equipment is new, use modifier NU; if rented, use modifier RR.

    Noneligible modifier submissions

    Certain claims are not eligible for reimbursement under the modifier rules.

    ONE OR MORE

    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyDME Modifiers for New, Rented, and Used Equipment
    Policy CodePolicy G-06053
    Change TypeNo material change
    Effective DateMar 26, 2026
    Last ReviewMar 26, 2026
    Next Review DateN/A
    Key ActionAppend modifier NU for new equipment or modifier RR for rented equipment, and place it in the primary or first modifier field.
    SourceLink
    On This Page
    Equipment Eligibility and Reimbursement ConditionsReimbursement ModifiersClaim Submission RequirementsEquipment and Device Definitions

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

  1. Equipment is used and billed with modifier UE.
  2. Equipment is submitted without the appropriate reimbursement modifier.
  3. A supply is appended with NU, RR, or UE without a state or CMS requirement.

    4. Reimbursement Modifiers

    Reimbursable equipment modifiersModifierCovered
    NUNew equipment
    RRRented equipment
    Nonreimbursable used equipment modifierModifierNot Covered
    UEUsed equipment

    Claim Submission Requirements

    Billing Rule

    Bill eligible equipment with the appropriate modifier

    Append modifier NU for new equipment or modifier RR for rented equipment. Place the applicable reimbursement modifier in the primary or first modifier field.

    • NU: new equipment
    • RR: rented equipment
    Denial Risk

    Do not bill used equipment

    Do not submit used equipment for reimbursement with modifier UE. The health plan does not allow reimbursement for used equipment.

    • UE: used equipment
    • Used equipment is not reimbursable under this policy.
    Billing Rule

    Restrict modifier use to equipment categories

    Use NU, RR, and UE only for applicable durable medical equipment, prosthetics, and orthotics. Do not append these modifiers to supplies unless required under state or CMS guidelines.

    • Applicable categories: DME, prosthetics, and orthotics
    • Claims for supplies appended with NU, RR, or UE are not eligible for reimbursement unless required under state or CMS guidelines.
    Denial Risk

    Include a valid reimbursement modifier

    Submit equipment claims with the appropriate valid reimbursement modifier in the primary or first modifier field. Claims submitted without the appropriate reimbursement modifier are not eligible for reimbursement.

    • Required modifiers: NU for new equipment or RR for rented equipment
    Billing Rule

    Apply the applicable reimbursement rate

    Reimbursement for properly submitted equipment claims is based on the applicable fee schedule or contracted or negotiated rate.

    • The claim must identify the equipment status with a valid reimbursement modifier.

    Equipment and Device Definitions

    Durable Medical Equipment (DME)
    Primary purposePrimarily and customarily used to serve a medical purpose rather than convenience or comfort.
    DurabilityCan withstand repeated use.
    Medical necessityGenerally not useful to a person without an illness or injury.
    Place of useAppropriate for use in the home.
    Prescription requirementPrescribed by a licensed physician/practitioner.
    Prosthetic Device
    DefinitionAn artificial structural and functional replacement of a limb or appendage or an internal organ.
    Functional replacementMay replace all or part of the function of a permanently inoperative or malfunctioning internal body organ.
    Replacement typeProvides both structural and functional replacement.
    Orthotic Device
    DefinitionA brace with rigid metal or plastic stays applied to the body.
    Support or immobilizationUsed for support or immobilization of a body part.
    Corrective or restorative purposeUsed to correct or prevent deformity or to assist or restore function.