2025 HCPCS code RA
Modifier RA is used when a supplier provides a new DMEPOS item to replace one that has been lost, stolen, or irreparably damaged.
Medical necessity for the original DMEPOS item must still be established, and the replacement must be of comparable medical necessity to the original item.
The DMEPOS supplier is responsible for applying this modifier and maintaining appropriate documentation.
In simple words: You would use this code if your medical equipment was lost, stolen, or broken beyond repair and your supplier gives you a new one.
This modifier is appended to a DMEPOS claim when a new item, identical to the original, replaces one lost, stolen, or irreparably damaged."Irreparable damage" includes damage from accidents, disasters, daily use, or other events exceeding normal wear and tear. Documentation should detail the circumstances of the replacement.Modifier RA applies whether the item's reasonable useful lifetime (RUL) has been met or not.When billing for an item past its RUL, suppliers are encouraged to note "RUL" and the original item's delivery date.
Example 1: A patient's wheelchair is damaged in a car accident and cannot be repaired. The supplier provides a new, identical wheelchair. Modifier RA is applied., A patient loses their CPAP machine while traveling. The supplier provides a replacement. Modifier RA is applied., A patient's walker breaks down due to extensive daily use, exceeding its reasonable useful lifetime.The supplier delivers a new walker and bills with modifier RA, noting the RUL and original delivery date.
Documentation must detail the circumstances of the loss, theft, or irreparable damage, justifying the need for a replacement item. If the item has reached its RUL, this should also be documented, along with the date the original item was supplied.
- Specialties:Applicable to specialties that prescribe and supply DMEPOS, such as orthotists, prosthetists, and durable medical equipment suppliers.