Repair Modifiers Tool

Revised 08.18.17:  CMS is adopting a new interpretation of the statute that impacts how adjustments to the fee schedule based on information from competitive bidding programs apply to wheelchair accessories used with group 3 complex rehabilitative power wheelchairs. Effective July 1 2017, fee schedule amounts for wheelchair accessories and back and seat cushions used with group 3 complex rehabilitative power wheelchairs will not be adjusted using information from the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. The fee schedule amounts will be based on the unadjusted fee schedule amounts updated by the annual fee schedule covered item update. Suppliers should continue to use the KU modifier when billing for wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs with dates of service beginning July 1, 2017. HCPCS codes E0958 and E1020 billing recommendations were also updated.

New: Repair Modifier Tool spreadhseetMicrosoft Excel File

Repair Modifier Tool

Select whether the base equipment is…

CGS has created this tool to assist suppliers in determining the appropriate modifiers for claim submission. This self-service tool should only be utilized to determine the modifiers for use when billing a replacement for wheelchair accessories incident to a repair. The Repair Modifiers Tool includes frequently billed wheelchair replacement codes and modifier suggestions, including the KU modifier. The list is not all inclusive or indicative of coverage. Suppliers are responsible for ensuring all requirements are met for the appropriate use of modifiers.

Please read the information below regarding critical billing instructions for appropriate use of the Repair Modifiers Tool.

Under the Medicare DMEPOS Competitive Bidding Program (CBP), repairs of medically necessary beneficiary-owned items can be performed by any Medicare-enrolled supplier. Effective October 1, 2016, payment for repair parts used to make medically necessary beneficiary-owned base equipment serviceable will be made on a lump sum purchase basis. When billing for replacement parts to repair base equipment, the RB modifier must be utilized. This applies to all repair parts billed with the RB modifier, regardless of whether the beneficiary resides within a competitive bidding area (CBA), outside of a CBA or whether the base equipment being repaired is subject to competitive bid or not. These rules apply to not otherwise classified (NOC) and specified codes.

When billing for replacement parts, in addition to the RB modifier, the NU pricing modifier and the appropriate informational modifiers (KH, KX, RT, and/or LT, etc.) are necessary.  The pricing modifier (NU) should directly follow the HCPCS code on the claim line.

It is recognized that there may be situations where the overflow modifier 99 is needed on a claim line. Modifier 99 must be utilized when it is necessary to bill more than four (4) modifiers on a single claim line. The overflow modifiers must be placed in the claim narrative. The pricing modifier, RT and LT (as needed) modifiers, and the 99 modifier (as needed) must all appear on the claim line. With the exception of the modifiers that must appear on the claim line, all others can be added to the claim narrative.

Example (99 modifier not needed)
E0992 NU RB KX

Example (99 modifier needed)
K0015 NU RT LT 99 (Narrative includes RB, KX, KH, and sometimes KU)

Additional Notes:
When replacing items in the capped rental category, the KH modifier must be added to the claim.

The following modifier combinations are invalid for submission:

RB and KY;
RB and KE; and
RB and RR.

Related Education:

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