Back to Insights and Updates for ProvidersMay 2024

Bill capped rental modifiers as appropriate

Tufts Health Plan Senior Care Options  |  Tufts Health Together  |  Tufts Medicare Preferred

Point32Health would like to remind our provider network that capped rental durable medical equipment (DME) items (i.e., DME items that may only be reimbursed for a certain number of months per CMS) should be billed with the appropriate capped rental modifier, in accordance with correct coding practices.

Effective for dates of service beginning July 1, 2024, any capped rental item that is billed without the proper accompanying capped rental modifier (outlined in the chart below) for Tufts Health Together members may be denied, consistent with our current experience for members of our Tufts Health Plan Senior Care Options and Tufts Medicare Preferred plans.

As a reminder, when billing capped rental equipment codes for Medicare and MassHealth members, you must use modifier KH for the first month of the rental, modifier KI for the second and third months, and modifier KJ for months four through 13. It is not appropriate to report modifier RR throughout the rental period.

KH​​ ​Initial claim, either rent (first month) or purchase
​KI ​Second or third month rental
​KJ​ ​Rental month four to 13
NU New equipment
UE Used durable medical equipment

When billing for new and used equipment purchases, providers must continue using the NU (new) and UE (used) modifiers.

Point32Health has updated our Durable Medical Equipment and Medical Supplies Payment Policy for Tufts Health Plan products to include information on billing requirements and modifiers for capped rental DME items.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

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