US · guidance
CMS Pub. 100-04, ch. 20, § 50.5
Payment of a Part of a DMEPOS Item
The RB modifier is used on a DMEPOS claim to denote the replacement of a part of a
DMEPOS item (base equipment/device) furnished as part of the service of repairing the
DMEPOS item (base equipment/device). All repair part claims billed with the RB
modifier, whether within or outside a competitive bidding area, shall be paid on a lump
sum purchase basis.
Payment for repair parts that are described by HCPCS codes for competitive bidding
items and are furnished in competitive bidding areas for use in repairing base equipment
that are competitive bid items is made based on the single payment amount established
for the HCPCS code. Payment for such repair parts that are furnished for use in repairing
base equipment that are not competitive bidding items in the area is made in accordance
with 42 CFR 414.408(k)(1)(ii), which provides that payment for the part is made based
on the contractor’s consideration of the item under 42 CFR 414.210(e). When making
payment determinations for parts described by HCPCS codes for competitive bidding
items furnished for use in repairing base equipment that are not competitive bidding
items, contractors have discretion to use the single payment amounts for the item in
establishing the Medicare allowed amount for the repair part.
History
(Rev. 3593, Issued: 08-17-16, Effective: 10-01-16, Implementation: 10-03-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
d459ae9fd396ffc937a6f73115aea2ce1a14502562e86862b552c57374083f8e
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