BU - JA DME

The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision

Suppliers must give Medicare beneficiaries the option to either purchase (BP) or rent (BR) their PEN pump at the time the item is first furnished. The beneficiary also has the option of purchasing a PEN pump any time during the rental period. Use of modifiers BR, BP, and BU is required to identify the option the beneficiary has requested.

When billing for PEN pumps, suppliers must append all other applicable modifiers in addition to BP, BR or BU.

Correct Use

• If beneficiary opts to rent PEN pump or is undecided at time pump was furnished, submit monthly claims with pricing modifier RR, BR or BU and any additional required modifiers
  • Up to 15 monthly rental payments will be made
• If modifier BP, BR, or BU is not provided on initial claim, supplier may include it on a subsequent claim; however, claim must be received no later than 10th of month

Incorrect Use

• Do not append to subsequent claim(s)
• Submitting a subsequent claim, after 10th month, with modifier BP, BR, or BU that was not provided on initial claim. Claim will deny

Appeal Option

• Redetermination may be requested for denial of subsequent claim submitted after the 10th of month and containing modifier BP, BR, or BU that was not provided on initial claim