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Thread: DME Medicare Billing -help!

  1. #1
    Join Date
    Apr 2007

    Default DME Medicare Billing -help!

    AAPC: Back to School
    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.

  2. #2


    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.

  3. #3


    Can someone tell me where to find information on what the documentation requirements are for orthotics and other L code supplies? Does the file need to contain a receipt, invoice, or something describing what was received, beyond simply the words "ordered L0630" written in the chart notes? It seems there should be something more but I can't find where that is stated. Thank you for your help!

  4. #4



    Copy and paste the above address in web browser
    Key: Control + F
    Type: HCPCS in question (ex: L0630)
    Select: link starting with "L" to the right of code for the Local Coverage Determination and also review the link that starts with "A" for the Policy Article.

    I attached a visual
    Attached Images Attached Images

  5. #5

    Default Guide to dme billing

    Can anyone recommend a publication that teaches about DMS Billing?

  6. #6

    Default Guide to dme billing

    Can anyone recommend an publication that gives basic guidelines for DME Billing?

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