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Modifier BR

Beneficiary Elects to Rent DME

Modifier BR identifies when a beneficiary has been informed of the available purchase and rental options for eligible durable medical equipment (DME) and chooses to rent the equipment rather than purchase it.

On This Page

Related Modifiers

Modifier BP

Purchase Election

Modifier BU

No Election

Modifier RR

Rental Equipment

When to Use

When NOT to Use

BR vs. BP & BU

Billing Example

Election Rules

Documentation

Billing Errors

FAQs

What Is Modifier BR?

Modifier BR is a HCPCS Level II modifier used to identify a beneficiary's decision to rent durable medical equipment after being informed of the available purchase and rental options.

Its official descriptor is “The beneficiary has been informed of the purchase and rental options and has elected to rent the item.”

Modifier BR is primarily associated with the beneficiary election requirements for certain DME items classified as inexpensive or routinely purchased under Medicare payment rules.

Unlike Modifier RR, which identifies equipment furnished on a rental basis, BR specifically communicates the beneficiary's informed decision to rent rather than purchase.

Important: Modifier BR is not required for every DME rental. Its use depends on the equipment's Medicare payment category and applicable payer instructions.

Quick Reference

Modifier: BR

Type: Beneficiary Election

Category: DMEPOS

Meaning: Rental Election

Billing: Rental

Notice: Purchase/Rental Options

When to Use Modifier BR

Beneficiary Elects Rental

Report BR when the beneficiary has been informed of the available purchase and rental options and affirmatively chooses to rent eligible DME.

Eligible Equipment Category

Use BR for equipment subject to the applicable beneficiary purchase/rental election requirements.

Purchase and Rental Options Explained

Confirm that the beneficiary received the required information about both payment options before making a decision.

Documented Rental Election

Maintain documentation establishing that the beneficiary selected the rental option.

Payer Requires BR

Append BR when Medicare or another payer requires the modifier to identify the beneficiary's rental election.

Important: A rental transaction alone does not justify reporting BR. The beneficiary must have made an informed rental election under the applicable payment policy.

When NOT to Use Modifier BR

Beneficiary Elects Purchase

Do not report BR when the beneficiary chooses to purchase eligible equipment. Modifier BP may be appropriate instead.

No Election Made

Do not use BR when the beneficiary has not selected either option. Modifier BU may apply after the required 30-day period under the applicable election rules.

Standard Rental Without Election Requirements

Do not automatically append BR to equipment furnished under ordinary rental arrangements that do not require a beneficiary election.

Purchase and Rental Options Not Explained

Do not report BR when the required notification has not occurred or the beneficiary's rental election cannot be established.

Equipment Not Eligible

Do not use BR with equipment outside the applicable purchase/rental election framework.

Important: BR identifies a beneficiary's rental choice, not the equipment's condition, rental month, or medical necessity.

Modifier BR vs. BP and BU

Modifiers BR, BP, and BU communicate different outcomes of the beneficiary election process.

Modifier BR – Rental Election

The beneficiary has been informed of the available options and chooses to rent the equipment.

Modifier BP – Purchase Election

The beneficiary has been informed of the available options and chooses to purchase the equipment.

Modifier BU – No Election After 30 Days

The beneficiary has been informed of the available options but has not made a decision after the applicable 30-day period.

BR vs. RR

Modifier RR identifies equipment furnished on a rental basis. Modifier BR identifies the beneficiary's informed rental election. They serve different billing purposes and should be combined only when supported by payer instructions.

Key Difference: BR, BP, and BU describe the beneficiary's election status, while RR describes the equipment's rental billing arrangement.

Billing Example

A Medicare beneficiary requires a standard manual wheelchair for use at home.

The supplier determines that the wheelchair qualifies for the applicable purchase/rental election requirements and explains both options to the beneficiary.

The beneficiary chooses to rent the wheelchair, and the supplier documents the election before submitting the claim.

Example – Manual Wheelchair Rental:

K0001-BR

Claim Details:

HCPCS Code: K0001 – Standard Wheelchair

Modifier BR: Beneficiary Elects Rental

Equipment: Manual Wheelchair

Transaction: Rental

Documentation: Rental Election Record

Medical Necessity: Required

Important: This example illustrates a rental election. The supplier must verify the applicable Medicare payment category, current modifier requirements, and any additional modifiers required by the payer before submitting the claim.

Beneficiary Purchase Election Rules

Medicare establishes specific requirements for beneficiary purchase and rental elections involving certain DME payment categories.

Beneficiary Notification

For equipment subject to the election requirements, suppliers must inform beneficiaries of the available purchase and rental options.

Documenting the Election

The beneficiary's decision must be documented. A rental agreement alone may not establish that the required purchase option was explained.

30-Day Election Period

Modifier BU identifies situations in which the beneficiary has been informed of the options but has not made an election after 30 days.

Modifier BR should reflect an affirmative rental election rather than an assumption based on the absence of a purchase decision.

Rental Payment Requirements

The rental election does not override Medicare payment limitations, coverage requirements, or the equipment's applicable rental reimbursement rules.

Beneficiary Financial Responsibility

Deductibles, coinsurance, and other financial obligations continue to depend on Medicare coverage and the applicable payment arrangement.

Important Billing Rule: Not all DME categories allow beneficiaries to choose between rental and purchase. For example, Medicare capped rental equipment generally follows a separate payment framework.

Documentation Requirements

Modifier BR claims must be supported by records demonstrating that the beneficiary was informed of the applicable purchase and rental options and elected to rent the equipment.

Equipment Order

Maintain a valid order identifying the prescribed equipment and supporting the applicable coverage requirements.

Medical Necessity

Document the beneficiary's medical condition and the need for the equipment.

Purchase and Rental Notification

Retain documentation showing that the beneficiary was informed of the available payment options.

Rental Election Record

Document the beneficiary's decision to rent, including the election date.

Rental Agreement

Maintain the agreement identifying the equipment, rental terms, and applicable payment arrangement.

Documentation Checklist

Valid equipment order retained
Medical necessity supported
Purchase and rental options explained
Beneficiary rental election documented
Equipment eligibility confirmed
Rental agreement and delivery records retained

Important: Documentation must demonstrate that the beneficiary actively elected rental when required. Simply billing monthly rental payments does not establish a valid election.

Common Billing Errors and Denials

Modifier BR claims may be denied when the beneficiary election, equipment eligibility, or supporting documentation does not satisfy payer requirements.

Missing Rental Election

Reporting BR without documentation confirming that the beneficiary elected to rent the equipment.

Incorrect Election Modifier

Using BR when the beneficiary selected purchase or had not made an election.

Required Notification Not Provided

Failing to inform the beneficiary of the applicable purchase and rental options before recording the election.

Ineligible Equipment Category

Appending BR to equipment that does not qualify for the applicable beneficiary election arrangement.

Incorrect Rental Billing

Submitting rental claims that do not comply with the equipment's payment category, billing frequency, or payer requirements.

Insufficient Medical Necessity Documentation

Failing to establish that the equipment meets the applicable coverage criteria.

Understanding Rental Election Denials

When a Modifier BR claim is denied, review the Claim Adjustment Reason Code (CARC) and any associated Remittance Advice Remark Codes (RARCs).

For example, CO-16 identifies a claim or service with missing information or submission errors needed for adjudication. The accompanying remark codes may help identify the specific issue.

For explanations of adjustment codes and guidance on resolving medical billing denials, visit DenialCodeLookup.com.

Important: Verify the beneficiary election, rental history, equipment category, and payer requirements before correcting or appealing a denied claim..

Frequently Asked Questions

Can a beneficiary switch from renting to purchasing equipment after electing rental?

A beneficiary may request a change, but whether the election can be changed depends on the equipment's payment category, previous rental payments, and payer requirements. Suppliers should verify the applicable policy before changing the billing arrangement.

Does Modifier BR have to be reported on every monthly rental claim?

Not necessarily. The modifier requirements depend on the equipment category and payer billing instructions. Suppliers should determine whether BR is required on subsequent rental claims rather than assuming it must be reported every month.