Samuel A. Collins
Question: I recently had a denial for TENS unit belt indicating I was missing a modifier. What is the modifier I would need in this case?
Some insurers will pay for a TENS unit, E0720 for a two-lead or E0730 for a four-lead, with the use of the Health Care Common Procedure Coding System (HCPCS) code alone. However, there are modifiers that are appropriate for billing durable medical equipment (DME), and payers are increasingly not making payments unless the necessary modifiers are present.
New vs. Used, Purchase vs. Rental
In your example, the modifier the insurer is looking for is to indicate that the equipment is new or used, and whether it was for purchase or was for rental. That modifier would be NU to indicate new equipment and for purchase alone. If the unit is a rental and was new when rented, use modifier NR. If used when rented, indicate UE for used and then RR for rental.
Common DME Modifiers
Here are the common modifiers for DME in a chiropractic setting:
Rental Modifiers. These modifiers indicate an item has been rented:
- RR Rental
- KH Initial claim, purchase or first-month rental
- KI Second or third monthly rental
- KJ Capped rental months four to 15
- KR Partial month
Purchase Modifiers. These modifiers indicate an item has been purchased:
- NU New equipment (use the NR modifier when DME which was new at the time of rental is subsequently purchased)
- UE Used equipment
- NR New when rented
- LT = Left RT = Right (if applicable)
HCPCS vs. CPT Modifiers
HCPCS modifiers, like CPT modifiers, are always two characters and are added to the end of a HCPCS or CPT code. When differentiating between a CPT modifier and a HCPCS modifier, there's one simple rule: If the modifier has a letter in it, it's a HCPCS modifier; f the modifier is entirely numeric, it's a CPT modifier.
A complete list and reference for HCPC modifiers is available at https://www.hcpcsdata.com/Modifiers.
Editor's Note: Submit billing questions to Mr. Collins at sam@hjrossnetwork.com. Your question may be the subject of a future column.
