Modifier RA — replacement of DME/orthotic/prosthetic item
Defines when Premera recognizes Modifier RA on professional claims to indicate replacement of member-owned durable medical equipment (DME), orthotic, or prosthetic items and explains required accompanying modifiers and documentation; applies to Premera and affiliated lines of business.
This policy is archived effective May 7, 2026 and refers readers to the Durable Medical Equipment (DME)/Home Medical Equipment (HME): Rental to Purchase policy.
Clarified guidelines for appending modifiers for rental and purchased replacement DME items and that replacement DME needs two modifiers to identify rental or purchase.
Identified specific replacement, rental and purchase modifiers (RA, RR, LL, KR, NU, NR, UE) in Codes/Coding Guidelines.
When Replacement Is Recognized
Replacement modifiers and documentation criteria
Conditions under which replacement is recognized and the claim submission and documentation requirements:
Replacement reasons (one or more):
- Reasonable deterioration over time
- Item is non-functional and cannot be repaired
- Loss, theft, or stolen
- Accidental or irreparable damage to the item
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