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| Reminder: Instructions for Providing and Billing Used Equipment National Government Services, the Jurisdiction B durable medical equipment Medicare administrative contractor (DME MAC) received questions related to billing for used equipment during the May 2009 Medicare 201 seminars. Suppliers are reminded for payment purposes, used equipment is considered routinely purchased equipment and is any equipment that has been purchased or rented by someone before the current purchase transaction. Used equipment also includes equipment that has been used under circumstances where there has been no commercial transaction (e.g., equipment used for trial periods or as a demonstrator) and equipment that has been refurbished. Pricing modifiers are used to define the appropriate fee schedule allowance for an item or service billed. Pricing modifiers are required for items classified as inexpensive or routinely purchased (IRP) durable medical equipment, items requiring frequent or substantial servicing, and capped rental items. For IRP items that can be purchased at the time the item is first furnished (power wheelchairs or parenteral/enteral pumps), suppliers must specify whether the equipment is new (NU) or used (UE) by indicating the appropriate pricing modifier on the claim. In cases where more than one modifier is required on the claim, the pricing modifier must be placed first, following the Healthcare Common Procedure Coding System (HCPCS) code, and all subsequent modifiers should follow. Payment for purchase of new equipment is equal to 100 percent of the single payment amounts established for these items. Payment for purchase of used equipment is reimbursed at 75 percent of the fee schedule amount. If the supplier fails to indicate whether the equipment is new or used on an assigned paper claim, the DME MAC will assume the equipment is used and process the claim. If the supplier fails to indicate whether the equipment is new or used on an electronic claim, the DME MAC will reject the claim with a CO-16, and the supplier will need to resubmit the claim. If durable medical equipment (DME) is rented for several months and subsequently purchased, the supplier must append the modifier UE to the claim line and the payment calculation will be based upon the fee schedule for the new piece of equipment and the rental payments shall not exceed the actual charge for the purchase. ExampleE0143 UE (used wheeled adjustable or fixed height walker, purchased) For additional information regarding used equipment, visit the Centers for Medicare & Medicaid Services (CMS) Web site, Internet Only Manual, 100-4, Chapter 20, section 30.1.1. |
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