decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Durable_Medical_Equipment / How_to_bill_for_unnecessary_upgraded_items
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Article Overview
This short Find-A-Code article focuses on durable medical equipment billing under Medicare when a patient chooses an item with extra features that are not medically necessary. It outlines the general circumstances under which suppliers may charge the beneficiary, the role of an Advance Beneficiary Notice, and the documentation needed on the claim form. The article is relevant to DME suppliers, billing staff, and coders who handle Medicare claims involving upgraded equipment and related claim remarks.
Why This Topic Matters
Improper handling of upgraded DME items can affect beneficiary liability, claim submission, and Medicare payment processing. Understanding the billing and documentation framework helps suppliers submit cleaner claims and record the upgrade appropriately.
What You Will Learn
- How Medicare billing may work when a beneficiary requests an upgraded durable medical equipment item
- How an Advance Beneficiary Notice relates to beneficiary responsibility for extra charges
- What claim documentation is mentioned for reporting an upgrade on the Medicare claim form
- How the article frames the role of the GL modifier in upgraded-item billing
Who Should Read This
- Durable medical equipment suppliers
- Medical coders
- Billing staff
- Revenue cycle staff
- Medicare claim specialists
Modifiers Discussed
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