Billing for a temporary replacement piece of equipment can create misunderstanding in the DME industry. Let’s try to clear up some of that misunderstanding by reviewing the HCPCS code K0462 which is a temporary replacement for patient owned equipment being repaired, any type. Medicare will cover a temporary replacement equipment when a patient owned equipment that is still medically necessary takes longer than one day to repair; however, they only pay up to one month’s rental for any item.
Medicare does not allow separate payment for repairs for DMEPOS items if the equipment is in a capped rental phase; this is the responsibility of the supplier. Basic maintenance and routine servicing such as testing, cleaning, or regulating is not covered for patient owned equipment because it’s the expected that patient will perform the maintenance.
If the patient owned equipment takes longer than one day, temporary loaner equipment may be justified as indicated in the following scenarios.
- Ordering parts that are not in stock to repair the equipment. It’s expected the supplier will have some stock such as batteries, tires, nuts, bolts, battery chargers, etc.
- If the patient owned equipment needs to be sent to the manufacturer for repair such as CPAP or BIPAP.
- Multiple repairs need to be made which may take longer than one day.
When billing for a temporary loaner, the K0462 must be submitted with the claim for repairs (labor & parts) on the second line, and must contain the following:
ü HCPCS code of the equipment being repaired, and
ü HCPCS code of equipment being provided as loaner, and
ü Detailed description of what is being repaired, and
ü Explanation as to why the repair took longer than one day
This information needs to be listed in Item 19 of the CMS-1500 form or the note segment for electronic claims. Remember there is a character limit of 80 so abbreviations are necessary. No modifiers are required with the K0462, but may be required with the code you are replacing.
**** NOTE**** the date on the line for the K0462 will be the date you delivered the loaner equipment and not the same date at the actual completion of the repair. These can (and should) still be billed on same claim; just the dates will be different.
The KX is required on accessories and if the original equipment required it. Use the RA if the replacement is for DME item itself when the entire item is being replaced. RB is for replacement part of DME furnished as part of a repair. Don’t forget the KE modifier on any part or accessory that could be part of round 1 competitive bid base item and KY for any item in round 2.