Replacement - RA Modifier Clarification

NAS has seen an increase in claims where the RA modifier is used inappropriately.  The RA modifier is described as replacement of a DME item, due to loss, irreparable damage, or when the item has been stolen.

The meaning of the replacement modifier has not changed and the following rules still apply:

The RA modifier should only be used on the first month rental claim for a replacement item.

A narrative explaining the reason for the replacement, if it happens prior to the useful lifetime of the item being reached, i.e., five years for most DMEPOS, is required on the claim.

A new order or Certificate of Medical Necessity (CMN), if applicable, is required.

If the RA modifier is reported inappropriately, the claim will be denied as unprocessable with remark code M51: Missing/incomplete/invalid procedure code.  These claims will need to be resubmitted.

For further clarification, please refer to either the New Repair and Replacement Modifiers or New Repair and Replacement Modifiers - Clarification articles.

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