DME billing with documentation that survives an audit
Billing for durable medical equipment suppliers: DME MAC jurisdictions, rental, purchase modifiers and more.
How DME billing works
Medicare DMEPOS claims go to the DME MAC for the jurisdiction where the beneficiary lives (Jurisdictions A, B, C and D), not where the supplier is located. Each item must meet coverage criteria in its Local Coverage Determination (LCD), supported by a standard written order and medical records from the treating practitioner.
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Modifiers tell the payer whether the item is new, used, rented or purchased, and whether documentation requirements were met.
Codes we bill every day
| Code | What it covers |
|---|---|
| RR / NU / UE | Rental, new purchase and used purchase |
| KX | Coverage requirements in the LCD are met and documented |
| KH / KI / KJ | Capped rental months 1, 2–3 and 4–13 |
| GA / GZ | ABN on file, or expected denial without ABN |
| RT / LT | Right and left side items |
Code descriptions are summarized. Payer coverage and documentation rules vary by plan and state.
Denials we prevent
- Missing or incomplete standard written order
- Medical records not supporting the LCD criteria
- Same or similar equipment already billed for the patient
- Item delivered before a required written order or prior authorization
- Supplier not accredited or enrolled for that product category
Payer rules to watch
Medicare requires prior authorization for some items, including power mobility devices and certain orthoses, and DMEPOS suppliers must revalidate Medicare enrollment every 3 years. Medicaid and commercial plans add their own authorization and quantity rules.
Questions about DME billing
Do you check documentation before delivery?
Yes. We review the order and medical records against the LCD before the item ships, when it is still easy to fix.
Do you handle capped rentals?
Yes. We track rental months and the right modifier for each month.
Get a free DME billing audit
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.