RA - JD DME
Replacement of a DME, Orthotic or Prosthetic Item due to loss, stolen, or irreparable damage
When replacement is due to loss, stolen, or irreparable damage, suppliers should append the RA modifier (to first month rental claim) for a capped rental Durable Medical Equipment (DME) item, or purchased prosthetic or orthotic item. For claims with this modifier, a narrative must be included explaining the reason for replacement, if replacement is prior to the Reasonable Useful Lifetime (RUL) of the 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 the Lower Limb Prostheses (LLP) exception below (CMNs required for dates of service prior to January 1, 2023 only).
- Oxygen: Append to oxygen claims when replacement of the equipment is necessary due to end of RUL or lost, stolen or irreparably damaged equipment. Do not append this modifier to any other DMEPOS item when replacing due to end of 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 the prosthesis as originally ordered still fills the beneficiary's medical needs.
- 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 Requirements on the CMS website for all claims submitted to DME MACs regarding refill requirements.
Last Updated Thu, 01 Dec 2022 20:39:44 +0000