BP - JA DME
The beneficiary has been informed of the purchase and rental options and has elected to purchase the item.
Claims must specify whether equipment is rented or purchased. For purchased equipment, the itemized bill or claim must also indicate whether equipment is new or used.
The following can be either rented or purchased:
- Complex rehabilitative power wheelchairs (HCPCS codes K0835-K0843 and K0848-K0864)
- Options/accessories furnished for use with a complex rehabilitative power wheelchair
- Parenteral/enteral pumps
Suppliers must give Medicare beneficiaries the option to either purchase (BP) or rent (BR) an item at the time it is first furnished. The beneficiary also has the option of purchasing a parenteral/enteral pump any time during the rental period. Use of modifiers BR, BP, and BU (undecided) is required to identify the option the beneficiary has requested.
When billing for complex rehabilitative power wheelchairs, options, and accessories, and parenteral/enteral pumps, suppliers must append all other applicable modifiers in addition to BP, BR, or BU.
- Append on initial claim with pricing modifier NU or UE and any additional required modifiers such as KH for complex rehabilitative power wheelchairs
- Lump-sum reimbursement for wheelchair or pump will be made
- If modifier BP, BR, or BU is not provided on initial claim, supplier may include it on a subsequent claim for parenteral/enteral pump; however, claim must be received no later than 10th month
- Do not append to subsequent claim(s), (see exception for parenteral/enteral above) only the initial requires the BR, BP, BU
- Submitting a subsequent claim, after 10th month, with modifier BP, BR, or BU that was not provided on initial claim.
- Beneficiary was initially undecided or chose to rent pump, then later decided to purchase it
- Redetermination may be requested for denial of subsequent claim submitted after the 10th month containing modifier BP, BR, or BU that was not provided on initial claim
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 20, Section 30.7.1
Last Updated Tue, 27 Sep 2022 18:15:27 +0000