Key takeaways
- Modifiers tell the payer how an item was supplied: purchased new, purchased used, or rented, and for which rental month.
- KH, KI and KJ group rental months, so a rental claim with the wrong one is a common denial.
- KX means the item’s coverage policy has been met and the records prove it. Add it only when that is true.
- GA, GY and GZ describe coverage and patient liability, and work together with the Advance Beneficiary Notice (ABN).
What DME modifiers do
A modifier is a two-character code added to a HCPCS code. In DME billing, modifiers carry information the code itself cannot: whether the item is new or used, purchased or rented, which month of a rental it is, whether a coverage policy has been met, and who is liable if the claim is denied. A wrong or missing modifier can change the payment or cause a denial even when the code is right.
The list below covers the modifiers suppliers use most. Always check the current policy for the item and the payer, because rules differ by item and contractor.
The common DME modifiers
| Modifier | Meaning | When it is used |
|---|---|---|
| NU | New equipment | Purchase of new equipment |
| UE | Used equipment | Purchase of used equipment |
| RR | Rental | Item is rented, not purchased |
| KH | Initial claim | First month of a rental, or a purchase that falls under the rental rules |
| KI | Second or third month | Rental months two and three |
| KJ | Later months | Rental from month four onward, and certain pumps |
| KX | Policy requirements met | Item’s coverage criteria are satisfied and records are on file |
| RA | Replacement | Replacing an item because of loss, theft or irreparable damage |
| RB | Replacement part | Part replaced as part of a repair |
| MS | Maintenance and servicing | Maintenance for covered, owned equipment, where allowed |
| LT / RT | Left or right side | Items that apply to one side, such as many orthoses |
| GA, GY, GZ | Coverage notices | Used with the ABN; see below |
Rental modifiers: RR, KH, KI and KJ
For capped rental items, the first claim carries RR with KH, months two and three carry RR with KI, and later months carry RR with KJ. The exact modifier set depends on the item and the contractor, so confirm it before you set up your billing system. If a month is skipped or billed with the wrong group, the payer may deny it or pay the wrong amount.
Track the rental month for every patient on every item. A simple monthly list that shows the next modifier to use prevents most of these errors.
Purchase modifiers: NU, UE and NR
NU marks a purchase of new equipment and UE a purchase of used equipment. When an item that was new at the start of a rental is later purchased, the NR modifier can apply. Use the one that matches how the item was supplied, and be able to show it from your delivery records.
KX: requirements met
KX tells the payer that every requirement in the item’s medical policy has been met and the supporting records are in the file. Use it only when that is true, and only on items whose policy calls for it. Adding KX to a claim whose criteria are not met can lead to a repayment demand on audit. See our KX modifier guide for details, including therapy thresholds.
GA, GY and GZ
These modifiers describe coverage and who pays if the item is denied. GA means a signed Advance Beneficiary Notice is on file and a denial is expected. GZ means the supplier expects a denial but has no ABN on file. GY marks an item that is statutorily excluded or not a Medicare benefit. Our GA, GY and GZ guide explains each one with examples.
Common modifier mistakes
- Billing rental months with the same modifier every month.
- Using KX without confirming every policy criterion and the records behind it.
- Billing a purchase as a rental, or the reverse.
- Missing LT or RT on items that apply to one side.
- Using GZ when an ABN was in fact obtained, or GA without a valid signed notice.
DME modifiers FAQ
What does the NU modifier mean?
NU means new equipment. It is added to the HCPCS code when a supplier is billing for the purchase of a new item.
What is the difference between KH, KI and KJ?
They mark rental months for capped rental items. KH is the first month, KI is months two and three, and KJ is the later months. Always confirm the exact rules for the item.
What does RR mean in DME billing?
RR means the item is rented. It is used with the rental month modifiers on rental claims.
When do you use the RA modifier?
RA is used when an item is replaced because it was lost, stolen or irreparably damaged. Policies differ, so check the item’s rules.
What does the KX modifier mean on a DME claim?
KX means the requirements in the item’s medical policy have been met and the records are on file. Do not add it unless that is true.