Wiki DME modifiers

[dknapp0367]

Hey,
I am billing a DME product (left knee brace) L1832 I have billed with modifiers, LT, NU and also billed without a modifier. The insurance is Cigna Healthsprings and they have denied it every way that I have sent the claim in. Any suggestions on what modifier to use?

 

[kathrynw]

Hi,
I would call the insurance and find out why it is denying. They might be able to provide some further guidance on if it is a modifier issue, diagnosis code etc.

 

[moralespris922]

Hi there I used to do DME billing for 9 yrs. and if they follow medicare guidelines which I think Cigna HS is?... I remember Nordian wanting only the NU, LT, KX. The KX may be necessary on that claim. KX indicated to payer that policy criteria is met and medical necessity is documented. Sometimes I would find that just the NU KX would be sufficient enough. Also Cigna can give you billing guidelines if they allow for purchase or rental. Which I would imagine a purchase if medicare allows for both too. Hope that helps!

 

[mfinn]

LT and KX should be fine...

 

[RyanRaichCPC]

I tend to use directionality and the KX modifiers for my DME and am being successfully reimbursed.