Modifier Lookup Tool - JA DME

This tool is intended to assist suppliers in determining potential modifiers that may be used in billing DMEPOS HCPCS codes. Many pricing and informational modifiers can be found by utilizing this tool.

The claim form can capture up to four modifiers. If more than four modifiers are needed, use modifier 99 (overflow) as the fourth modifier and enter the additional modifiers in the narrative field of the claim.

• Modifier placement on claim
  • First position - Pricing modifiers. i.e., RR, KH, KI, KJ, NU
  • Second position - Modifiers to indicate requirements specified in the medical policy have been met. i.e., KX
  • Other positions - Any additional informational modifiers required

Modifiers can be alphabetic, numeric, or a combination of both, but will always be two digits. Some modifiers cause automated pricing changes, while others are used to convey information only. They are not required on all HCPCS codes; however, if required and not submitted, the claim will deny as unprocessable. Be sure to distinguish between zeros and the letter "O".

RT and LT modifiers - When billing for bilateral items on the same date of service:

• Bill bilateral items on two separate claim lines using the RT and LT modifiers and 1 unit of service (UOS) on each claim line

GA or GZ or GY, and KX must never be used on the same claim line together as the claim will deny as unprocessable and the claim will need to be corrected and rebilled.

Some miscellaneous codes may require a specific modifier according to the policy and laterality modifiers shown on the tool, as well as additional details provided in the claim line narrative.

Disclaimer: This tool does not include all DMEPOS modifiers or HCPCS codes and does not guarantee coverage for the item(s) billed. Refer to the Modifiers page and appropriate Local Coverage Determination and/or Policy Article for additional modifier usage.