How are durable medical equipment (DME) coded?

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Durable Medical Equipment (DME) is coded using HCPCS Level II codes, specifically in the E-series (E0100–E8000). These codes are established by CMS (Centers for Medicare & Medicaid Services) and are used for billing supplies and equipment that are medically necessary and prescribed for patient use.

What qualifies as DME?

To be considered DME, an item must:

• Be able to withstand repeated use

• Be primarily used for a medical purpose

• Be appropriate for use in the home

• Be prescribed by a physician

Examples include wheelchairs, walkers, oxygen equipment, CPAP machines, hospital beds, and infusion pumps.

How DME is coded:

1. Use HCPCS Level II codes

   • All DME items are assigned E-codes (e.g., E0114 for a walker, E0601 for a CPAP machine).

2. Modifiers may be required

   • Modifiers give additional information such as:

     • RR – Rental

     • NU – New equipment purchase

     • UE – Used equipment purchase

     • KH, KI, KJ – Capped rental modifiers

     • GA, GY, GZ – For Medicare coverage exceptions or denials

   Example: E0601RR means the CPAP machine is being rented.

3. Documentation is essential

   • A prescription and supporting medical necessity documentation must be maintained and often submitted for Medicare or insurer approval.

Summary:

DME is coded using HCPCS Level II E-codes, with modifiers to describe the status (rental, new, used, etc.). Accurate coding ensures proper reimbursement and compliance, especially when billing Medicare or Medicaid.

Read More

What is the purpose of G-codes in HCPCS?

When is it appropriate to use HCPCS codes over CPT codes?

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