Wiki Dme modifiers

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lkaplan

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I am new to DME billing. I have a Medicare patient who uses CPAP and bleed in oxygen. He does not qualify for the oxygen per Medicare Guidelines, signed an ABN and pays cash. He does want me to bill Medicare for the rejetion. I have tried multiple modifier combos without success - any suggestions?:confused:
 
lkaplan said:
I am new to DME billing. I have a Medicare patient who uses CPAP and bleed in oxygen. He does not qualify for the oxygen per Medicare Guidelines, signed an ABN and pays cash. He does want me to bill Medicare for the rejetion. I have tried multiple modifier combos without success - any suggestions?:confused:
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What exactly do you mean by "without success"? Is the claim being rejected? Or being processed but not showing patient responsibility? What does the EOB show?
 
Meagan,

Claim edit states the modifier combination is invalid. It never gets past the claim edit due to these errors. I have a CMN for the CPAP, but he does not qualify for the oxygen. I am billing for the concentrator so it will deny as not medically necessary.
 
lkaplan said:
Meagan,

Claim edit states the modifier combination is invalid. It never gets past the claim edit due to these errors. I have a CMN for the CPAP, but he does not qualify for the oxygen. I am billing for the concentrator so it will deny as not medically necessary.
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Do you bill DME to CGS? And what CPT code are you billing?
 
lkaplan said:
No - Region A goes to NHIC. E1390 is the HCPCS.
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Ok, here's a little info I found. We don't bill any oxygen supplies, so I'm really not familiar with all this, but check out the slides starting on page 18 for all the modifiers allowed by NHIC for oxygen-related supplies. Also, don't forget about the ABN modifiers...are you familiar with those?

Here's the site from NHIC:

http://www.medicarenhic.com/viewdoc.aspx?id=2782
 
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