September 2019

Noridian Updates RA Modifier Guidelines for DMEPOS

Noridian, the Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) for Jurisdictions A and D, has updated its guidelines regarding use of the RA Modifier, which is to be used for replacement of a DME, orthotic, or prosthetic item.

Correct Use

  • Append to replacement claims (to first month rental claim) for a capped DME, prostheses, and orthoses rental item. Circumstances warranting replacement of these items may include loss, theft, or irreparable damage (not all inclusive).
  • If submitting a claim with this modifier, the narrative must be included explaining the reason for replacement, if replacement is prior to the Reasonable Useful Lifetime (RUL) of the item.

Note: If applicable, a new order or Certificate of Medical Necessity is required for replacements.

Exceptions

  • Oxygen: Append to oxygen claims when replacement of that equipment is necessary due to RUL. Do not append this modifier to any other DMEPOS item when replacing due to RUL.
  • Lower Limb Prostheses: Replacement of a prosthesis or prosthetic components required because of loss or irreparable damage may be reimbursed without a physician’s order when it is determined that the prosthesis as originally ordered still fills beneficiary’s medical needs.

Incorrect Use

  • Append to claims for purpose of replacing parts or accessories as part of a repair. Refer to Modifier RB for use in this situation.
  • Append to claims for replacement of supplies (refills).
  • To read the update, which includes links to resources, visit med.noridianmedicare.com/web/jadme/topics/modifiers/ra.

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