Dynamic Adjustable Devices, Static Progressive Stretch Devices, and Use of Modifiers - JA DME
Dynamic Adjustable Devices, Static Progressive Stretch Devices, and Use of Modifiers
Joint DME MAC Publication
Posted on January 2, 2025
Claims submitted to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for finger devices coded as the following HCPCS codes must include one of the following HCPCS modifiers on the claim line.
HCPCS Codes
| Code | Description |
|---|---|
| E1825 | DYNAMIC ADJUSTABLE FINGER EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1826 | DYNAMIC ADJUSTABLE FINGER EXTENSION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1827 | DYNAMIC ADJUSTABLE FINGER FLEXION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
HCPCS Modifiers
| Code | Description |
|---|---|
| FA | LEFT HAND, THUMB |
| F1 | LEFT HAND, SECOND DIGIT |
| F2 | LEFT HAND, THIRD DIGIT |
| F3 | LEFT HAND, FOURTH DIGIT |
| F4 | LEFT HAND, FIFTH DIGIT |
| F5 | RIGHT HAND, THUMB |
| F6 | RIGHT HAND, SECOND DIGIT |
| F7 | RIGHT HAND, THIRD DIGIT |
| F8 | RIGHT HAND, FOURTH DIGIT |
| F9 | RIGHT HAND, FIFTH DIGIT |
Failure to append the modifier to claim lines submitted with these HCPCS codes will result in a rejection for incorrect coding.
Claims submitted to the DME MAC for toe devices coded as the following HCPCS codes must include one of the following HCPCS modifiers on the claim line.
HCPCS Codes
| Code | Description |
|---|---|
| E1828 | DYNAMIC ADJUSTABLE TOE EXTENSION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1829 | DYNAMIC ADJUSTABLE TOE FLEXION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1830 | DYNAMIC ADJUSTABLE TOE EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1831 | STATIC PROGRESSIVE STRETCH TOE DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES |
HCPCS Modifiers
| Code | Description |
|---|---|
| TA | LEFT FOOT, GREAT TOE |
| T1 | LEFT FOOT, SECOND DIGIT |
| T2 | LEFT FOOT, THIRD DIGIT |
| T3 | LEFT FOOT, FOURTH DIGIT |
| T4 | LEFT FOOT, FIFTH DIGIT |
| T5 | RIGHT FOOT, GREAT TOE |
| T6 | RIGHT FOOT, SECOND DIGIT |
| T7 | RIGHT FOOT, THIRD DIGIT |
| T8 | RIGHT FOOT, FOURTH DIGIT |
| T9 | RIGHT FOOT, FIFTH DIGIT |
Failure to append the modifier to claim lines submitted with these HCPCS codes will result in a rejection for incorrect coding.
Claims submitted to the DME MAC for shoulder, elbow, forearm, wrist, knee, and ankle devices coded as the following HCPCS codes must include one of the following HCPCS modifiers on the claim line.
HCPCS Codes
| Code | Description |
|---|---|
| E1800 | DYNAMIC ADJUSTABLE ELBOW EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1801 | STATIC PROGRESSIVE STRETCH ELBOW DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES |
| E1802 | DYNAMIC ADJUSTABLE FOREARM PRONATION/SUPINATION DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1803 | DYNAMIC ADJUSTABLE ELBOW EXTENSION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1804 | DYNAMIC ADJUSTABLE ELBOW FLEXION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1805 | DYNAMIC ADJUSTABLE WRIST EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1806 | STATIC PROGRESSIVE STRETCH WRIST DEVICE, FLEXION AND/OR EXTENSION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES |
| E1807 | DYNAMIC ADJUSTABLE WRIST EXTENSION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1808 | DYNAMIC ADJUSTABLE WRIST FLEXION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1810 | DYNAMIC ADJUSTABLE KNEE EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1811 | STATIC PROGRESSIVE STRETCH KNEE DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES |
| E1812 | DYNAMIC KNEE, EXTENSION/FLEXION DEVICE WITH ACTIVE RESISTANCE CONTROL |
| E1813 | DYNAMIC ADJUSTABLE KNEE EXTENSION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1814 | DYNAMIC ADJUSTABLE KNEE FLEXION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1815 | DYNAMIC ADJUSTABLE ANKLE EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1816 | STATIC PROGRESSIVE STRETCH ANKLE DEVICE, FLEXION AND/OR EXTENSION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES |
| E1818 | STATIC PROGRESSIVE STRETCH FOREARM PRONATION / SUPINATION DEVICE, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES |
| E1822 | DYNAMIC ADJUSTABLE ANKLE EXTENSION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1823 | DYNAMIC ADJUSTABLE ANKLE FLEXION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1840 | DYNAMIC ADJUSTABLE SHOULDER FLEXION / ABDUCTION / ROTATION DEVICE, INCLUDES SOFT INTERFACE MATERIAL |
| E1841 | STATIC PROGRESSIVE STRETCH SHOULDER DEVICE, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES |
HCPCS Modifiers
| Code | Description |
|---|---|
| LT | LEFT SIDE |
| RT | RIGHT SIDE |
When bilateral shoulder, elbow, forearm, wrist, knee, or ankle devices are billed on the same date of service, bill each item on a separate claim line using the RT and LT modifiers (one modifier on each claim line) and 1 unit of service (UOS) on each claim line. Do not use the RT and LT modifiers on the same claim line with 2 UOS. Claim lines billed without an RT or LT modifier, or with RT and LT modifiers on the same claim line and 2 UOS, will result in a rejection for incorrect coding.
Publication History
| Date of Change | Description |
|---|---|
| 01/02/25 | Originally Published |
