CurrentHumanaPolicy CP2024013

Durable Medical Equipment (DME) for Medicare Advantage

Defines Humana's billing requirements and reimbursement rules for durable medical equipment supplied to Medicare Advantage members, including rental vs purchase, capped rental items, oxygen, TENS units, and related supplies/accessories.

Policy Summary

PayerHumana

PolicyDurable Medical Equipment (DME) for Medicare Advantage

Policy CodePolicy CP2024013

Change TypeNo material changes

Effective DateOct 1, 2025

Next Review Date

Key ActionFor items that can be rented or purchased, determine and follow any applicable referral or prior authorization requirements before billing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

13 monthscapped rental period (months)

36 monthsoxygen rental limit

2 monthsTENS trial (chronic)

10% / 7.5%non-power wheelchair rates

15% / 6%power wheelchair rates

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General and capped rental criteria

General reimbursement rules and capped rental treatment

DME reimbursed according to CMS guidance unless this policy differs; providers should follow applicable CMS guidance when not overridden by this policy.

For a DME item that can be rented or purchased, whether that item is rented or purchased is subject to any applicable referral or prior authorization determination.

When the Medicare DMEPOS Fee Schedule has no rental rate for an item that can be rented, Humana will apply a contracted rental rate where applicable; if there is no contracted rental rate, Humana may allow the item at the purchase rate.

Purchase amount allowed depends on purchase modifier reported: NU = new equipment purchase rate; UE = used equipment purchase rate (used equipment typically allowed at a reduced rate, typically 75% of new).

Capped rental items: if a charge is submitted with modifier RR, the amount allowed is the monthly rental rate; rental allowed for continuous use not to exceed 13 months; a capped rental DME item is considered purchased after 13 continuous months of covered rental.

Humana may allow payment at the purchase rate at any time regardless of submission of modifier RR; in such cases the amount allowed is either the new equipment purchase rate or used equipment purchase rate as described above.

Monthly rental rates (when not under a contract): non-power wheelchair — 10% of purchase rate for each of the first three months then 7.5% thereafter; power wheelchair — 15% for first three months then 6% thereafter; monthly rental rate is based on the purchase rate in effect for the date of service billed.

Oxygen

Oxygen-specific coverage and billing rules

Humana allows reimbursement for rental of oxygen equipment for continuous use not to exceed 36 months; only one supplier is reimbursed per month; stationary and portable equipment each have their own 36-month continuous allowance.

A gap in service of 60 days or more during a 36-month rental period restarts the 36-month rental period; a gap of fewer than 60 days does not restart the period.

Humana requires modifier RR for rental of oxygen equipment; the monthly rental rate may be adjusted based on the prescription and the supplier must report one of the modifiers QA, QB, QE, QF, QG or QR as supported by the prescription to determine the adjusted monthly rental amount.

Modifier adjustments

If stationary equipment billed with QA or QE, amount allowed = 50% of the monthly rental rate.

TENS units

TENS unit-specific coverage rules for acute and chronic pain

Acute post-operative pain: Humana allows a one-month rental period for TENS units; supplier must submit the charge with modifier RR.

Chronic pain: Humana requires a two-month rental trial period to assess suitability for ongoing treatment; supplier must submit charges for the two-month trial with modifier RR; Humana requires an appropriate transaction modifier for chronic pain.

The two-month rental trial does not count toward the 13-month capped rental period or toward the purchase amount.

If the TENS unit is approved for ongoing use and charges are submitted with modifier RR, monthly rental is allowed for continuous use not to exceed 13 months; Humana reserves the right to allow payment at the purchase rate at any time regardless of submission of modifier RR.

Conversion to purchase: after the two-month trial, the device is considered purchased in the month in which the total of all amounts allowed (for one or multiple charges) reaches the applicable purchase amount or when rental exceeds the 13-month rental period; if the unit is purchased after rental, the purchase rate is based on the purchase rate in effect at the time of the first month's rental.

Billing Codes and Modifiers

Common transaction and purchase modifiersModifier

RR	Rental modifier — monthly rental rate applies for capped rental items and specified devices (e.g., TENS, oxygen).
NU	New equipment purchase modifier — new equipment purchase rate allowed.
UE	Used equipment purchase modifier — used equipment purchase rate allowed (typically 75% of new rate).

Oxygen-specific modifiers and rate adjustmentsModifier

QA/QE	Stationary oxygen – 50% of monthly rental rate.
QG/QR	Stationary oxygen – 150% of monthly rental rate.
QF/QB	Portable oxygen – greater of 50% of stationary monthly rate or 100% of portable monthly rate.

inv-06: TENS purchase conversion threshold

Purchase conversion ruleDevice is considered purchased in the month when cumulative allowed rental amounts (for one or multiple charges) reach the applicable purchase amount.

13‑month conversion thresholdDevice is considered purchased if rental exceeds 13 continuous months; the 13‑month cap applies to capped rental items and TENS units (rental allowed up to 13 months).

Two‑month trial exclusionThe two‑month rental trial for chronic TENS use does not count toward the 13‑month rental cap or toward the purchase amount.

Purchase modifier impactIf purchased after rental, supplier must submit appropriate purchase modifier; amount allowed is new or used purchase rate as described in General Policy Guidelines.

Provider Billing & Documentation Actions

Prior Authorization

Prior authorization/referral requirement

For items that can be rented or purchased, whether rented or purchased is subject to any applicable referral or prior authorization determination.

Billing Rule

Oxygen modifier reporting

For oxygen equipment rentals, report modifier RR and, as supported by the prescription, report one of QA, QB, QE, QF, QG or QR to determine adjusted monthly rental rates. Humana determines amounts allowed as follows: - Stationary equipment with modifier QA or QE: 50% of the monthly rental rate. - Stationary equipment with modifier QG or QR: 150% of the monthly rental rate. - Portable equipment with modifier QF or QB: the greater of 50% of the monthly rental rate for stationary equipment or 100% of the monthly rental rate for portable equipment.

Report modifier RR for rental of oxygen equipment.
Report oxygen adjustment modifier(s) QA, QB, QE, QF, QG, or QR as supported by the prescription to determine adjusted monthly rental rates.

Key Definitions

inv-09: NU / UE — purchase modifiers NU/UE

NU (New equipment)Charge submitted with modifier NU is allowed at the new equipment purchase rate.

UE (Used equipment)Charge submitted with modifier UE is allowed at the used equipment purchase rate (typically 75% of the new equipment purchase rate).

Action requiredReport NU or UE on the purchase claim to determine whether new or used purchase rate applies.

inv-10: Capped rental DME item

Required modifiersSuppliers must submit the appropriate capped rental modifier and transaction modifier for capped rental DME items (e.g., RR for rental).

Rental period governanceCapped rental items are governed by defined rental schedules; rental allowed for continuous use not to exceed 13 months unless otherwise specified.

Monthly rental calculationWhen billed with RR, amount allowed is the monthly rental rate as described by Humana (contracted rental rate if applicable or percentage of purchase rate).

Humana discretionHumana may allow payment at the purchase rate at any time regardless of RR submission.

inv-11: Reasonable Useful Lifetime (RUL)

RUL durationReasonable Useful Lifetime (RUL) for oxygen equipment is at least five years.

RUL start dateThe RUL begins with the initial month's rental.

Replacement implicationA new 36‑month rental period may begin if equipment meets the RUL (>= five years) or is lost, stolen, or unintentionally damaged beyond repair.

OpenPayer

Durable Medical Equipment (DME) for Medicare Advantage

Coverage and Rental Rules

Billing Codes and Modifiers

Provider Billing & Documentation Actions

Key Definitions