Modifier RA

Replacement of a DME, Orthotic or Prosthetic Item for loss, stolen or irreparable damage

Correct Use

When replacement is due to loss, theft or irreparable damage suppliers should append the RA modifier (to first month rental claim) for a capped rental Durable Medical Equipment (DME) item or prostheses and orthoses purchase item. For claims with this modifier, a narrative must be included explaining reason for replacement, if replacement is prior to Reasonable Useful Lifetime (RUL) of item. The reason for replacement should be documented in the supplier's records and may include a beneficiary statement, police report, fire or insurance report, etc.

Note: If applicable, a new order or Certificate of Medical Necessity (CMN) is required for replacements. See Lower Limb Prostheses (LLP) exception below.

Exceptions

  • Oxygen: Append to oxygen claims when replacement of that equipment is necessary due to RUL or loss, stolen or irreparably damaged equipment.  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

Incorrect Use

  • Appending to claims for purpose of replacing parts or accessories as part of a repair. Refer to Modifier RB for use in this situation
  • Appending 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.

Resources

 

Last Updated Thu, 20 Feb 2020 16:03:32 +0000