Claim Narratives - JA DME

There are many situations that a claim will require a narrative on the claim for the claims processing to complete timely. When adding a narrative to the claim it should be entered in Item 19 of the 1500 hard copy claim form or the 2400/NTE segment of an electronic claim. Due to the limitation of space for narratives there are some common abbreviations that can be used when submitting paper and electronic claims with a narrative.

Below are some of the situations that require a narrative on the claim:

• Billing DMEPOS accessory/supplies provided on a recurring basis when a three-month supply is allowed. Please review the refill requirements section of each individual LCD for further details. - Standard Documentation Requirements Article
  • When billing more than one month's supply of these items, include a narrative in the NTE segment of the electronic claim or in Item 19 of the 1500 hard copy claim indicating the number of months you are billing. For example, if you bill a three-month supply of PAP accessories (i.e., mask, tubing, cushions), you must add "90-day supply" or "three-month supply". This additional information is required so that the DME MACs can correctly process the claim.
• Billing for repair labor
• Billing for minor parts without specific HCPCS codes
• Billing for loaner equipment (HCPCS K0462)
• Billing a Not otherwise classified (NOC) codes - Items billed with any HCPCS code with a narrative description that indicates miscellaneous, NOC, unlisted, non-specified, or not otherwise specified
  • Miscellaneous HCPCS codes billed without this information will be return/rejected for missing information. Denial on remittance advice - reason code 16, remark codes M51, N350
• When replacing an item and appending RA modifier due to loss, stolen or irreparably damaged
• When appending the RB modifier
• Non -Contracted Suppliers in competitive bid areas in certain situations
• Break in Need or Service and Break in Billing
• COVID-19 claims, initial dates of service (DOS) 03/01/20-05/11/23
• Certain Upgrade situations
• Billing Continuous Passive Motion (CPM) Devices
• Beneficiary-owned equipment when billing for accessories and supplies
• Accessories and Supplies Used with Beneficiary-Owned Equipment
• Canceled Orders for Customized Items (salvage value)
• Custom Fabricated Orthotics
• Anticipated discharge date is extended
• When narrative is required per the policy article
• If more than four modifiers are needed, use modifier 99 (overflow) as the fourth modifier and enter the additional modifiers in claim narrative
• Billing surgical dressings, when modifier A9 (dressing for nine or more wounds) is used, add number of wounds in narrative