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Durable Medical Equipment Billing


Durable Medical Equipment (DME) Billing is comprehensively examined and payor policies are forever varying.  Exceptional billing ability is essential to navigate the reimbursement regulations, provide a low denial rate and simplify the DME billing process while doing it efficiently and increasing revenue.


Vital Profits is dedicated to the accuracy and compliance of the DME provider submitted claims.  We reviews each claim for accuracy, and in agreement with the payor’s policy.  Any rejected claims that arise are immediately reviewed, corrected and resubmitted.  Vital Profits consistently makes every effort to stay up to date with any changes in payor policy that may affect cash flow.  Throughout the life of the claim, the provider or company can see its progress.  We are always available for any questions or concerns.


***Please read the following article affecting how you bill theraputic shoes***


RT and LT Modifier Usage Changes for Podiatric DME


By Carri Garbus, CMRM

As we begin 2019, we must deal with yet more coding changes. I’d like to share a new rule by CMS that becomes effective 3-1-2019 that will impact billing DME items. Please read the following podiatry specific text I pulled from a correct coding article published on the Noridian website. Note, this is not the complete article. The complete article can be found by clicking Correct Coding - RT and LT Modifier Usage Change.

Several DME MAC LCD-related Policy Articles Require the use of the RT and LT modifiers for certain HCPCS codes. The right (RT) and left (LT) modifiers must be used when billing two of same item or accessory on the same date of service and the items are being used bilaterally. Current instructions for billing products to be used bilaterally instruct suppliers to use the RTLT modifier on the same claim line and indicate two (2) units of service. This instruction is being changed in the Ankle-Foot/Knee-Ankle-Foot Orthoses (AFO/KAFO), Lower Limb Prostheses (LLP), Orthopedic Footwear and Therapeutic Shoes for Persons with Diabetes (TSD).


Effective for claims with dates of service (DOS) on or after 3/1/2019, suppliers must bill each item on two separate claim lines using the RT and LT modifiers and 1 UOS on each claim line. Do not use the combination RTLT modifier on the same claim line and bill with 2 units of service (UOS). Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT and/or LT modifiers or with the RTLT on a single claim line, will be rejected as incorrect coding.



If anyone has any questions regarding this new rule, or other billing or coding questions, please call Vital Profits at 855-VITAL-1-1. We would be happy to help!

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