Modifier RR, KR, LL — DME rental/lease modifiers
Defines when Premera recognizes and requires modifiers RR, KR and LL on professional CMS-1500/837P claims for durable medical equipment rental, partial-month rental, and lease-to-purchase billing; applies to Premera and affiliated lines of business.
Added a new section for Replacement of a DME, orthotic or prosthetic item referencing modifier RA and guidance about replacement after reasonable useful lifetime.
Added instructions for billing non-continuous daily rental periods (bill separate line for each unique date of service).
Clarified paragraph 3 in the "Policy" section.
Clarified the Purpose statement to indicate that the policy pertains to Professional services billed on a CMS-1500 or 837P claim forms.
DME Rental and Lease Coverage Criteria
DME rental/lease coverage criteria
Billing and coverage criteria for rented or leased durable medical equipment (DME):
ALL of the following
- One full month of rental equals one unit.
- Each full month must be billed on a single claim line with one unit (do not bill 30 units for a month).
ALL of the following
- Include a 'from' and a 'through' date of service on the claim.
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