How to Bill Durable Medicare Equipment (DME) Correctly?

It is no longer a secret that efficient DME billing relies on the coordination and collaboration of five key stakeholders. All working all together in sync not only helps in better ROI but seamless billing operations. While all of it begins with the patient, the end-user of durable medical equipment, who may be responsible for co-pays or deductibles the rest four are equally important. Starting from healthcare providers, the physicians who initially prescribe the DME based on medical necessity, followed by DME suppliers or Medicare Administrative Contractors (MACs) across the U.S.. Here he is who ensure timely delivery, setup, and maintenance of the equipment. All these are only the first half of the DME circle. 

The process, however, remains incomplete without the insurance companies and payers — including private insurers, Medicare, and Medicaid, who manage reimbursement for approved claims and expert DME billers to manage it all. In short, here the expertise of an experienced DME biller can make a huge difference. A skilled billing specialist here not only ensures accuracy, compliance and efficiency throughout the DME billing process but ultimately helps in driving faster reimbursements and minimizing denials. 

What types of codes are used to denote DME 

It is no secret that when billing DME, Durable Medical Equipment (DME) codes fall under the HCPCS (Healthcare Common Procedure Coding System) classification. While DME coders primarily use E-codes (E0100–E8002) to classify most items starting from hospital beds, oxygen equipment, wheelchairs and other assistive devices. It is important to note that in addition to E-codes, K-codes (K0001–K0900) are also used, though it is a little less than E-codes in the case of wheelchairs, accessories, and other specialized equipment. While it is seen that L-codes are typically reserved when it comes to orthotics and prosthetics, which often fall under the DMEPOS category.  

These HCPCS codes in fact, play a crucial role in ensuring accurate medical billing and plays a major role in  faster reimbursement. To further define billing specifics, a biller needs to use additional modifiers. Common examples include: 

• NU – New equipment 
• RR – Rental equipment 
• UE – Used equipment 
• RA – Replacement of a DME item 
• KX – Documentation required for Medicare compliance 

And remember all of these codes and modifiers together help DME providers with their claims getting billed correctly. And also, processed without unnecessary delays or denials.   

Related Reading: DME Billing Fraud: Why 2025 Is a Turning Point

Detailed HCPCS code ranges for the Durable Medical Equipment (DME)coding sheet: 

With so many codes, more than knowing it is vital to understand where and what top codes are commonly used for DME. 

1. Code E0601 – Continuous Positive Airway Pressure (CPAP) Device – This is one of the most frequently billed DME codes used for patients with sleep apnea. Here the code covers CPAP machines that deliver continuous positive airway pressure to maintain airway patency during sleep; thus, it is vital for patients struggle with sleep.
2. Code E1390 – Oxygen Concentrator (Single Delivery Port) – The E1390 code applies to stationary oxygen concentrators here. For this the coverage requires documentation of hypoxemia, typically when oxygen saturation is greater than 88%. This is a device for provides a consistent oxygen supply for patients with chronic respiratory conditions.
3. CodeE0431 – Portable Gaseous Oxygen System – This code covers portable oxygen tanks for patients who need mobility while receiving oxygen therapy. DME suppliers frequently bill E0431 for home-based or ambulatory oxygen users who require oxygen on the go.
4. Code A7006 – Administration Set for Nebulizer Medication – Although categorized under A-codes, A7006 is a commonly used CPT/HCPCS code by DME suppliers. It represents the nebulizer administration set, including tubing and mouthpiece or mask, used for inhalation treatments. Proper documentation of medical necessity is required for reimbursement.

While these are some of the common  codes, one need to be aware of the common mistakes associated with these codes, starting from: 

• E0601 (CPAP Device): here, denials often occur when sleep study reports or physician prescriptions which is compulsory, are missing or outdated for the prescribed DME product. 
• E1390 (Oxygen Concentrator): Missing oxygen saturation documentation or any kind of failure to record testing at resr or during sleep. Exertion are common mistake here.  
• E0431 (Portable Oxygen System): Here errors usually involve when billing both DME equipment E0431 and E1390 without a clear medical justification for portability. 
• A7006 (Nebulizer Administration Set): In this case any kind of incorrect linkage to a non-covered diagnosis or missing prescription details often leads to rejections. Thus, ensuring proper documentation, physician signatures and linking the right ICD-10 diagnosis codes helps and most importantly are key to preventing claim denials. 

When to Use the KX Modifier for DME 

The KX modifier is used when specific medical documentation is on file supporting that all Medicare requirements have been met for coverage. It signals to the payer that the DME supplier has maintained appropriate records. This includes all the medical necessities and physician orders, documents etc. 

While we all know it is a complex process and requires precise information, one of the common problems is identifying the DME billing coverage of the patient. Worry no more, as details below regarding the DME coverage might help you get a brief idea about its complications and solutions. 

A succinct perspective of DME Covered by Medicare  

Durable Medical Equipment (DME) is covered under Medicare Part B and not Part A. While Part A covers inpatient hospital or skilled nursing facility services, Part B covers medically necessary equipment used in the home setting. Thus, it includes wheelchairs, oxygen devices, hospital beds, and CPAP machines when prescribed by a physician. 

So if you a DME provider, DME supplier or Medicare Administrative Contractors (MACs)  and are nervous about how to bill your DME to Medicare – these five simple steps might be helpful: 

• Start with verifying the patient’s eligibility and coverage under Medicare Part B. 
• Try to obtain a valid physician order with documented medical necessity. 
• Consistently update yourself and ensure the accurate HCPCS DME codes for the product. Also, use the additional required modifiers for the durable medical equipment requested by the physicians to help them get identify if it is new (NU), rental (RR) or KX and RA). 
• Always remember to submit claims electronically through the appropriate Medicare Administrative Contractor (MAC). 
• Maintain documentation, be it prescriptions, delivery proof or even the patient signature for compliance and audit readiness. 

Always remember, proper billing ensures faster reimbursements and minimizes costly rejections and a convenient and cost-effective solution is outsourcing to the right DME billing company that has both experience and expertise. 

Related Reading: How Should You Reconsolidate DME Billing?

How SunKnowledge is an expert in streamlining your DME Billing for Medicare and Private Insurance 

Being a leading DME billing company offering complete back-office and front-end billing support to manage your submitted claims properly, SunKnowledge today is partnered with the largest DME client. With expertise in eligibility verification, prior authorization, coding, charge entry, denial management, and AR recovery, Sunknowledge ensures a 100% HIPAA compliant process guaranteed.  A team that works directly with DME suppliers, providers, and payers to reduce turnaround time, improve clean claim rates and achieve maximum reimbursement that too in client’s integrated software like Brightree, DME workd, Kareo etc. Partnering with SunKnowledge, which has both domain knowledge and automation and analytics, can eliminate billing errors and ensure seamless compliance with Medicare and Medicaid regulations in no time. Saving up to 80% of the additional cost at only $7 an hour, you can experience faster and improved ROI in no time. So, if you are wondering how to resolve billing complications, call us for support, and we are here to get your DME billing services sorted in no time.