Medicare requires compliance for Durable medical equipment, if you're talking CPAP machines that is. There are all different kinds of DME and different jursdictions that covers different areas. The modifer's required for a successful claim for CPAP machine rental are the RR for rental, KH for inital set up, KI for months 2-3, and KJ for months 4-13. The KX modifier is required to show you have the required documentation on file, for example- proof of delivery,physicians order, compliant use and f/u documentation, physicians statement.GZ modifier is required if you do not have the required documentation on file and expecting it to be denied, which you would need an ABN on file, at which point the GA modifier comes into play. Depending on who the DME Contractor is in your area, I would check out their website. I know the Noridian DME website who is the contractor in my area is very thorough and gives good information.
Michelle
I'm new to DME billing with Medicare. Our claims are being rejected with the LCD code attached. We're using the RT or LT modifier where required, GA modifer and place of service as 12, as required by Medicare. What am I missing? I did not receive a helpful response from Medicare and would appreciate any advice you can offer. We're in NJ if that makes a difference. Thanks.