DMEPOS Modifiers

Brittany Gonzalez, CPO
10-15-2025
Blog

What You Need to Know

Most HCPCS codes require specific modifiers, which provide additional information and billing context for accurate claim processing. DMEPOS providers must add the appropriate modifiers to each claim line to ensure timely and appropriate reimbursement. The following modifier categories are listed in the order they should be entered on the claim and include some of the most prevalent DMEPOS modifiers.

 

Pricing Modifiers

Rental or purchase modifiers (NU, UE, and RR) are required for inexpensive, routinely purchased, and capped rental items. They are identified on the Medicare fee schedule and typically do not apply to L-codes. Additional pricing modifiers (KH, KI, and KJ) must be added to capped rental items.

  • NU: New DME purchase
  • UE: Used DME purchase
  • RR: Rental
  • KH: Capped rental, first month rental
  • KI: Capped rental, second or third month rental
  • KJ: Capped rental, months four to thirteen

 

Medical Policy/Liability Modifiers

The Local Coverage Determinations and associated Policy Articles specify when a medical necessity modifier or liability modifier is required. Only one of these modifiers can be used on a single claim line, or the claim will be denied as unprocessable.

  • KX: Medical policy requirements are met
  • GA: A valid Advance Beneficiary Notice of Noncoverage (ABN) is obtained, and the item is expected to be denied as not reasonable or necessary
  • GZ: Item is expected to be denied as not reasonable or necessary, and a valid ABN is not obtained (the item will be automatically denied and not subject to complex medical review)
  • GY: Item is not covered by Medicare

 

Informational Modifiers

Additional modifiers may be required, depending on LCD/Policy Article requirements and/or specific billing scenarios.

  • RT or LT: Use to specify whether the device is for the right or left extremity (when billing for bilateral items on the same date of service, use two separate claim lines with the RT or LT modifier and 1 unit of service on each claim line)
  • ST: Use to bypass prior authorization in an emergency only
  • RA: Use for a replacement device when the original device was lost, stolen, or irreparably damaged
  • RB: Use for the replacement of a part of a device that is being repaired
  • GX: Use when a voluntary ABN is on file for an item that is not covered by Medicare (the item will be automatically denied and not subject to complex medical review)
  • CG: Use with codes L0450, L0454, L0621, L0625, and L0628 if they are made primarily of non-elastic material (e.g., canvas, cotton, or nylon) or have a rigid posterior panel
  • K0-K4: Use when billing for prosthetic devices that require a specific functional level for coverage (i.e., feet, ankles, knees, and hips)

What This Means For You

To help prevent denials and delays in payment, you must include the correct modifiers on your claims. Before billing Medicare, review the Medicare fee schedule and associated LCD/Policy Article, if applicable, to determine which modifiers are required. You can also use Noridian's Modifier Lookup Tool or CGS's Advanced Modifier Engine to determine the appropriate modifiers for a specific HCPCS code (both tools include information that applies to all DME jurisdictions). For a complete list of DMEPOS modifiers, including brief descriptions and links to more detailed information, visit Noridian's Modifiers page.

 

Note: These tools/rules are specifically for Medicare claims. Other payers may have different modifier requirements based on their individual reimbursement policies.