Reimbursement Policy — DME Modifiers for New, Rented, and Used
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Defines reimbursement requirements for Durable Medical Equipment (DME), prosthetics, and orthotics when billed with modifiers indicating new (NU), rented (RR), or used/purchased used (UE); applies to claims for members in MMC, HARP, Child Health Plus, and Essential Plan programs administered by Highmark BCBS WNY.
Reimbursement Conditions for NU / RR / UE Modifiers
Reimbursement criteria for NU/RR/UE modifiers
Covered when ALL of the following conditions are met:
Modifier and Code Guidance
| NU | Modifier for new equipment |
| RR | Modifier for rented equipment |
| UE | Modifier for purchase of used equipment |
Billing and Authorization Guidance
Bill DME/prosthetics/orthotics with NU, RR, or UE in primary/first modifier field
Bill durable medical equipment (DME), prosthetics, and orthotics with the appropriate reimbursement modifier — NU (new), RR (rented), or UE (used) — placed in the primary or first modifier field; claims for supplies appended with these modifiers are not eligible for reimbursement unless state or CMS guidelines explicitly require otherwise. Reimbursement is based on the applicable fee schedule or contracted/negotiated rate when the valid modifier is present; claims submitted without the appropriate modifier are not eligible for reimbursement.
- Place NU, RR, or UE in the primary or first modifier field to determine reimbursement per the fee schedule or contracted rate.
- Do not append NU, RR, or UE to supplies—such claims are not eligible for reimbursement unless state/CMS rules require it.
- Failure to follow coding/billing guidelines may result in rejection/denial, recoupment, or adjustment of payment.
Key Definitions
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