DME Billing Cheat Sheet (2026)
DME billing lives and dies on documentation that exists before the claim: a compliant order, a timely face-to-face, and the medical necessity that supports the item. The modifiers tell the payer which of those you have.
Quick reference for dme billers. Last updated .
Top DME CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 97760 | Orthotic management and training, initial encounter | $46.09 | $46.09 | 1.38 |
| 97761 | Prosthetic training, initial encounter | $40.42 | $40.42 | 1.21 |
| 97763 | Orthotic or prosthetic management, subsequent encounter | $50.10 | $50.10 | 1.50 |
| 95851 | Range of motion measurements per extremity | $26.05 | $6.68 | 0.78 |
| 97140 | Manual therapy techniques | $27.72 | $27.72 | 0.83 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the DME billing services page.
Modifiers That Prevent DME Denials
All coverage criteria in the medical policy are met and the supporting documentation is on file.
An ABN is on file because the item is expected to be denied as not medically necessary, preserving patient liability.
The item is expected to be denied as not reasonable and necessary and no ABN is on file, signaling no patient liability.
The item is statutorily excluded or not a Medicare benefit, routing it for the denial needed to bill secondary.
Rental (RR), new purchase (NU), or used purchase (UE), which the claim requires for correct pricing.
Laterality on items supplied for a specific side, required for adjudication.
Top DME Denials → Quick Fix
A complete order with the beneficiary, item, prescriber, and date must be on file before billing. An incomplete order is a documentation denial.
For items that require it, document the in-person encounter within the required window addressing the condition that supports the item.
KX attests the policy criteria are met. Append it only when the file actually supports it; an unsupported KX is an audit and recoupment risk.
Append RR, NU, or UE to match how the item was supplied. A pricing-modifier mismatch reprices or denies.
Append GY to obtain the denial needed to bill the secondary payer, rather than billing it as a covered service.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 97760 | 0213T | Misuse of Column Two code with Column One code |
| 97760 | 0216T | Misuse of Column Two code with Column One code |
| 97761 | 0213T | Misuse of Column Two code with Column One code |
| 97761 | 0216T | Misuse of Column Two code with Column One code |
| 97763 | 0213T | Misuse of Column Two code with Column One code |
| 97763 | 0216T | Misuse of Column Two code with Column One code |
| 95851 | 36591 | CPT Manual or CMS manual coding instruction |
| 95851 | 36592 | CPT Manual or CMS manual coding instruction |
Documentation That Holds Up on Appeal
The standard written order with all required elements, dated before or at delivery as the policy requires.
The in-person encounter within the required window documenting the condition that supports the item.
Every coverage criterion in the medical policy met, with the proof in the file before KX is appended.
The rental period and cap status, with RR and the month of rental.
Delivery to the beneficiary with date and signature, required to support the billed date of service.
Revenue DME Practices Leave on the Table
Billing before the compliant order and face-to-face are on file, guaranteeing a documentation denial.
Appending KX without the supporting file, which converts a paid claim into a recoupment.
Pricing-modifier mismatches between rental and purchase.
Not using GY on excluded items, which blocks the secondary payer from being billed.
DME Billing FAQ
What documentation has to exist before billing DME?
A complete standard written order, the face-to-face encounter for items that require one, the medical necessity for the item, and proof of delivery. Billing ahead of these is the most common DME denial.
What does the KX modifier mean?
It attests that every coverage criterion in the item's medical policy is met and the documentation is on file. Appending it without that support is an audit and recoupment exposure, not a shortcut.
GA, GZ, or GY, which applies?
GA when an ABN is on file for a likely medical-necessity denial, GZ when no ABN is on file for a likely denial, and GY for statutorily excluded items to get the denial needed to bill secondary.
Why do rental claims reprice?
Because the pricing modifier (RR rental, NU new, UE used) did not match how the item was supplied, or the rental month and cap status were not tracked.
Stop Losing DME Revenue to Preventable Denials
Our AAPC-certified dme coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.