Modifier RR- Rental of Durable Medical Equipment

Modifier RR identifies durable medical equipment (DME) that is being rented rather than purchased and supports proper Medicare rental payment processing.

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What Is Modifier RR?

Modifier RR is a HCPCS Level II modifier used when durable medical equipment is furnished on a rental basis. Medicare's descriptor is essentially “rental,” and DME MAC guidance instructs suppliers to append RR to the appropriate HCPCS code when DME is rented. Medicare

RR is important because Medicare payment rules differ depending on whether equipment is rented or purchased. The modifier tells the payer that the claim represents a rental payment rather than the purchase of the equipment.

Modifier RR may apply to rental equipment in several DME payment categories, including inexpensive or routinely purchased equipment, capped rental items, equipment requiring frequent and substantial servicing, and certain oxygen equipment. Medicare

When to Use Modifier RR

DME is being rented: Append RR to the appropriate HCPCS code when the equipment is supplied to the beneficiary on a rental basis.

Monthly rental billing: Use RR on applicable claim lines representing rental periods rather than the outright purchase of the equipment.

Capped rental equipment: RR is used with applicable capped rental DME. Depending on the rental month, additional modifiers such as KH, KI, or KJ may also be required to identify where the claim falls within the rental period. Centers for Medicare & Medicaid Services

Applicable DME payment categories: Medicare DME MAC guidance identifies RR for rental items in categories including inexpensive or routinely purchased DME, capped rentals, items requiring frequent and substantial servicing, and oxygen. Medicare

When NOT to Use Modifier RR

Equipment is purchased: Do not report RR when the claim represents the purchase of DME rather than a rental. Modifier NU may apply to new equipment being purchased when appropriate.

Used equipment purchase: RR should not be used simply because equipment was previously used. Modifier UE identifies used durable medical equipment when applicable.

Repair or replacement only: Do not use RR merely to indicate that rented equipment was repaired or replaced. Repair and replacement circumstances may require different modifiers and documentation.

Non-DME items: RR should not be appended simply because an item is temporarily provided to a patient. The item and claim must meet the applicable DME rental requirements.

Medicare DME Rental Periods

Rental billing is not always as simple as appending RR every month. The applicable DME payment category determines how Medicare pays for the equipment and which additional modifiers may be required.

For capped rental DME, Medicare uses modifiers that identify the stage of the rental period:

KH: Initial claim, purchase, or first rental month.

KI: Second or third rental month.

KJ: Months four through fifteen for applicable capped rental equipment.

These modifiers may be reported with RR when required by the equipment's payment category and rental month. Centers for Medicare & Medicaid Services

Suppliers should determine the DME payment category and applicable rental rules for the specific HCPCS code before submitting the claim.

Billing Example

A Medicare beneficiary requires covered DME that will be supplied on a monthly rental basis. The supplier furnishes the equipment and bills Medicare for the rental rather than selling the equipment to the beneficiary.

The applicable HCPCS equipment code is submitted with Modifier RR.

Example:
E0260-RR

If the equipment is subject to capped rental rules, the supplier may also need the appropriate rental-month modifier.

First rental month example:
E0260-RR-KH

The exact modifier combination depends on the equipment, rental month, payment category, and applicable Medicare billing requirements.

Partial-Month Rentals

Modifier RR may also interact with Modifier KR when a supplier bills an eligible DME rental for a partial month.

KR identifies a rental item billed for a partial month. Medicare DME MAC guidance states that RR and other applicable modifiers should also be reported on the claim when KR is used for a partial-month rental. Medicare

This distinction matters because RR identifies the item as rented, while KR identifies the partial-month rental period.

Documentation Requirements

Standard Written Order: Maintain a valid order for the DME. Medicare requires a new order for purchases and initial rentals, as well as in certain circumstances such as replacement or changes to the prescription. Centers for Medicare & Medicaid Services

Medical necessity: The beneficiary's medical record must support why the equipment is reasonable and necessary for the condition being treated.

Equipment details: Documentation should support the DME supplied and the HCPCS code reported on the claim.

Proof of delivery: Suppliers must maintain applicable documentation demonstrating that the beneficiary received the equipment.

Continued medical need: For ongoing rented DME, documentation may be required to demonstrate that the equipment continues to be reasonable and necessary. Medicare identifies timely records such as a recent order, changes to an order, or medical-record documentation showing use as potential support. Centers for Medicare & Medicaid Services

Continued use: Suppliers are responsible for monitoring whether the beneficiary continues to use rented DME and must stop billing Medicare when the beneficiary is no longer using the rental item. Centers for Medicare & Medicaid Services

Billing & Claim Considerations

Modifier RR should be reported on the same claim line as the HCPCS code representing the rented DME.

Before billing, suppliers should determine the item's Medicare payment category because the category affects rental duration, payment methodology, and whether additional modifiers are required.

For example, capped rental equipment can require KH, KI, or KJ in addition to RR depending on the rental month. Partial-month rental billing may require KR. Other DME circumstances can require additional modifiers related to medical necessity, beneficiary elections, replacement, or equipment condition. Centers for Medicare & Medicaid Services

Suppliers should also monitor continued use. Medicare specifically requires suppliers to discontinue billing when rented equipment is no longer being used by the beneficiary. Centers for Medicare & Medicaid Services

Common Billing Mistakes

Leaving RR off a rental claim: Failing to identify the equipment as rented can cause the claim to be processed under the wrong payment methodology.

Using RR for purchased equipment: RR indicates rental. Claims for purchased equipment should use the appropriate purchase-related modifier when required.

Missing rental-month modifiers: Capped rental claims may require KH, KI, or KJ in addition to RR.

Continuing to bill unused equipment: Suppliers should not continue monthly rental claims after the beneficiary stops using the equipment.

Incorrect HCPCS code: RR does not correct an incorrectly selected equipment code. The HCPCS code must accurately represent the DME furnished.

Insufficient medical necessity documentation: A correctly reported RR modifier does not overcome missing documentation supporting Medicare coverage.

Common Denial Reasons

Rental not permitted for the item: The HCPCS code or payment category does not support the rental billing submitted.

Incorrect modifier combination: RR is reported without another required modifier or with an incompatible modifier.

Rental period billed incorrectly: The claim does not correctly identify the applicable rental month or period.

Medical necessity not supported: The medical record does not establish that the DME is reasonable and necessary.

Missing or invalid order: The supplier cannot support the initial rental with the required order documentation.

Continued use not supported: Ongoing rental claims lack documentation supporting continued beneficiary use when required.

Coverage criteria not met: The equipment fails applicable Medicare coverage requirements even though RR was correctly appended.

Frequently Asked Questions

Does Modifier RR mean Medicare will continue paying for the equipment every month?
No. RR identifies the equipment as rented, but payment depends on the item's DME payment category, coverage requirements, rental period, continued use, and other applicable Medicare rules.

Can Modifier RR be reported with KH, KI, KJ, or KR?
Yes, when applicable. RR identifies the equipment as a rental, while KH, KI, and KJ can identify stages of certain rental periods and KR can identify an eligible partial-month rental. Centers for Medicare & Medicaid Services