🩺 DMEPOS Requiring Claim Narratives Chart

Overview

Certain DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) items or billing situations require a claim narrative when submitting claims to the DME MACs (CGS, Noridian, etc.). Narratives go in the NTE segment of electronic claims or Item 19 of the CMS-1500 form.

Continuous Passive Motion (CPM) Devices

Narrative must include:

Type of knee surgery performed
Date of surgery
Date of application of CPM
Date of discharge from the hospital

Beneficiary-Owned Equipment

When billing for accessories, supplies, repairs, or miscellaneous items for beneficiary-owned equipment, include:

HCPCS code of the base equipment
Date the beneficiary obtained the equipment
Statement indicating “beneficiary-owned”

K0462 – Temporary Replacement Equipment for Patient-Owned Equipment Being Repaired, Any Type

Include all of the following:

HCPCS code or manufacturer/brand name and model number of equipment being repaired
Purchase date of the original equipment
Manufacturer/brand name/model number of the replacement equipment
Description of what was repaired
Reason if repair took longer than one day to complete

K0739 – Repair or Non-Routine Service (Other Than Oxygen Equipment)

Itemize each repair with:

HCPCS code(s) that were repaired
Labor time per HCPCS code (listed in units or 15-minute increments; 1 unit = 15 min)
Total units or minutes must match the number billed

Example:

Claim narrative for 4 units of service:
E2359 – 30 minutes, E2381 – 30 minutes

Break-In-Billing (BIB)

Used when extending a rental period beyond the original 13 months.
Narrative must include:

“BIB”
Length of break
“Please extend rental period to [enter date needed]”

Break-In-Need

Used when there’s a break in medical necessity for an item.
Narrative must include:

Description of the beneficiary’s prior medical condition that required the previous item
Explanation of when and why that prior medical necessity ended
Explanation of the new or changed medical condition and when it began

Source: CGS Administrators, LLC (CMS)
Original February 10, 2021 – Revised November 27, 2023

📄 Additional DMEPOS Claim Narrative Requirements

Replacement Equipment (With RA Modifier)

Include all of the following in the claim narrative:

Enter RA modifier on the first month’s claim only
If within Reasonable Useful Lifetime (RUL), include narrative for reason(s) the equipment was replaced: stolen, lost, irreparably damaged
RUL Met – Replacement Equipment (include narrative):
- RUL met
- Beneficiary requested replacement
- Date beneficiary received the equipment being replaced
Supplier Exiting Medicare Oxygen Business
- If a new supplier is taking over, include:
  
  “Beneficiary acquired through supplier voluntarily exiting Medicare program” (or similar statement)

Not Otherwise Classified (NOC) Drugs

Enter drug name and dosage in the claim narrative.

Unlisted Procedure Code or NOC Code

When billing an HCPCS code that is miscellaneous, NOC, unlisted, or non-specified, include:

Description of the item or service
Manufacturer name
Product name and number
Supplier Price List (PL) amount
HCPCS code of related item (if applicable)
If it’s a customized option/accessory, clearly state what was customized.

Greater Than Four Modifiers

If a claim line requires more than four modifiers, include “99” in the fourth modifier position and describe the overflow modifiers in the NTE Note segment or Item 19.

🗓️ Greater Than a One-Month Supply

When providing more than a one-month supply (up to 90 days) of:

External Infusion Pump Supplies
Nebulizer Inhalation Medication
Nebulizer Administration Supplies
Ostomy Supplies (with some exceptions)
PAP or RAD Accessories
Urological Supplies

Claim narrative must include:

Statement indicating “3-month supply (90 days)” or the exact number of days billed.