HCPCS code K0739 for repair or non-routine service of DME equipment other than oxygen equipment should not be requested for Healthfirst Members with active rentals or active maintenance authorizations.
If a member has an active rental for a bed and informs that the bed is no longer working, the Provider should visit the Member to evaluate condition and then repair or replace the bed without requesting an authorization for K0739.
Or, if a Member no longer has an active rental but has an active maintenance authorization and informs that a bed is no longer working, the Provider should visit the Member to evaluate condition and then repair or replace the bed without requesting an authorization for K0739.
Submitting Claims
The following are reminders that apply when submitting claims:
- Monthly rentals are not to exceed the capped rental period of 13-months of continuous use for Medicare and 10-months of continuous use for Medicaid. These claims must be billed each time with the following modifiers:
First Modifier: RR
Second Modifier: KH, KI, or KJ
Modifier KH is used for the 1st month of the rental,
Modifier KI is used for the 2nd and 3rd months of the rental, and
Modifier KJ is used for rental months 4-13.
- Maintenance authorizations are approved for a 5-year duration after the Rent to Cap period. DME items billed for maintenance after the rental period will be reimbursable every 6 months. The Modifier: MS must be billed as the primary modifier during the maintenance period.
For questions related to this inSight or to request claims support, please submit an inquiry via the Inquiry Webform.
Thank you,
The Integra Team
