Replacement of a DME, Orthotic or Prosthetic Item
- Append to replacement claims (to first month rental claim) for a capped Durable Medical Equipment (DME), prostheses and orthoses rental item. Circumstances warranting replacement of these items may include loss, theft or irreparable (not all inclusive)
- If submitting claim with this modifier, narrative must be included explaining reason for replacement, if replacement is prior to Reasonable Useful Lifetime (RUL) of item
Note: If applicable, a new order or Certificate of Medical Necessity (CMN) is required for replacements. See Lower Limb Prostheses (LLP) exception below.
- Oxygen: Append to oxygen claims when replacement of that equipment is necessary due to RUL. Do not append this modifier to any other DMEPOS item when replacing due to RUL
- LLP: Replacement of a prosthesis or prosthetic components required because of loss or irreparable damage may be reimbursed without a physician's order when it is determined that prosthesis as originally ordered still fills beneficiary's medical needs
- Append to claims for purpose of replacing parts or accessories as part of a repair. Refer to Modifier RB for use in this situation
- Append to claims for replacement of supplies (refills)
Note: See standard documentation language in Chapter 3 of Noridian Supplier Manual or Documentation Requirements section of applicable Local Coverage Determination (LCD) for more information regarding refill requirements.
Last Updated Sep 18, 2019