| Patient Home Address: | , | DME Location: |
| HCPCS Code / Description: | - | $ |
| Modifier (if applicable): | ||
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Modifier Definitions: NU--Purchased, New RR--Rented UE--Purchased, Used KM--Replacement of Facial Prosthesis including new impression/moulage KN--Replacement of Facial Prosthesis using previous master mold AU--Urological, ostomy or trach item AV--Item with prosthetic/orthotic device AW--Item with a surgical dressing Equipment KE--Bid Under Round I of the DMEPOS Competitive Bid Program For Use With Non-Competitive Bid Base Equipment KF--Class III device KL-- DMEPOS Item Delivered Via Mail KC--Replacement of Special Power Wheelchair Interface KU-- DMEPOS Item Subject to DMEPOS Competitive Bidding Program Number 3 QB -- Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (lpm) and portable oxygen is prescribed QF -- Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed |
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| * Updated 1/1/2025 with January 2025 CMS files - Click here for CMS DMEPOS Fee Schedule Files
** Website is not for commercial use and may contain errors. Data is from CMS and USPS and current as of the date above ** |
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