HCPCS Level II • DME • Medicare Billing

Modifier NU

New Durable Medical Equipment

Learn what Modifier NU means, when it is reported, how it differs from UE and RR, and how medical billing teams can correctly handle DME purchase claims.

Start Learning Quick Cheat Sheet

New Equipment DME Purchase Modifier

Modifier NU at a Glance

The essential points every DME biller and AR caller should know.

New Equipment

CMS identifies NU as the modifier used to identify new equipment.

DME

DME Claims

NU is used with applicable DME HCPCS codes when the item is furnished as new equipment.

BUY

Purchase

CMS guidance uses NU for purchase of new equipment, subject to the applicable payment rules.

≠UE

Not Used Equipment

UE is used for used DME. NU identifies new equipment.

What Is Modifier NU?

A simple explanation of the DME modifier.

Official CMS Meaning

CMS identifies:

NU = New equipment

The modifier tells the payer that the DME item represented by the HCPCS code is new equipment.

CMS explains that HCPCS modifiers provide additional information about the item or service represented by the HCPCS code. :contentReference[oaicite:1]{index=1}

Plain-English Explanation

Think of NU as:

“This DME item is being furnished as new equipment.”

The HCPCS code identifies the actual DME item. The NU modifier provides additional information about the equipment’s status.

NU NEW

HCPCS DME ITEM

Key Point

NU describes the equipment as new; it does not replace the HCPCS code that identifies the actual DME item.

How Modifier NU Works

Understand the relationship between the HCPCS code, equipment status and claim.

Identify the DME

Start with the appropriate HCPCS Level II code for the DME item being furnished.

Determine Equipment Status

Determine whether the applicable item is new, used, rented or subject to another applicable billing rule.

Apply Applicable Modifier

When the applicable DME billing rules call for NU, report the HCPCS code with NU.

Verify Documentation

Confirm the order, medical necessity and supporting documentation required for the item.

Check Coverage

Confirm that Medicare or the applicable payer covers the DME item under the applicable benefit rules.

Submit the Claim

Submit the correct HCPCS code, applicable modifier and required claim information.

NU vs UE vs RR

One of the most important DME modifier comparisons.

Modifier	Meaning	Equipment Status	General Use
NU	New equipment	New	Applicable purchase claims for new DME
UE	Used durable medical equipment	Used	Applicable purchase claims for used DME
RR	Rental	Rental arrangement	Applicable DME rental claims
NR	New when rented	New at time of rental and subsequently purchased	Applicable circumstances where NR is required

Important Distinction

Do not automatically choose NU simply because the equipment is physically new. The claim must also satisfy the applicable DME payment and coverage rules, and the specific HCPCS code may have purchase/rental limitations.

Easy Way to Remember DME Modifiers

NU NEW

NU — New Equipment

Think: New + Purchase when applicable.

UE USED

UE — Used Equipment

Think: Used DME .

RR RENTAL

RR — Rental

Think: DME Rental .

Modifier NU Billing Workflow

Step-by-step workflow for DME billing teams.

1 Identify the patient’s coverage and payer.

2 Verify that the item qualifies under the applicable DMEPOS benefit category.

3 Identify the correct HCPCS Level II code.

4 Determine whether the item is new, used or being rented.

5 Determine whether NU is applicable to the item and transaction.

6 Verify the treating practitioner’s order/prescription requirements.

7 Verify medical necessity documentation.

8 Verify any applicable prior authorization or documentation requirements.

9 Confirm the DME item is eligible for purchase under the applicable payer rules.

10 Submit the HCPCS code with NU when applicable.

11 Monitor the claim through adjudication.

12 Investigate any denial using the ERA/EOB and supporting documentation.

DME Documentation Checklist

Documentation is critical even when the equipment is new.

    
        Beneficiary identification.
      
        Treating practitioner’s order/prescription when required.
      
        Order date.
      
        General description of the DME item.
      
        HCPCS code when included in the order.
      
        Quantity when applicable.
      
        Treating practitioner’s name or NPI.
      
        Treating practitioner’s signature when required.
      
        Medical necessity documentation.
      
        Delivery documentation.
      
        Proof of beneficiary receipt when applicable.
      
        Evidence supporting new equipment status.
      
        Applicable coverage requirements.
      
        Prior authorization documentation when required.
      
        Payer-specific DME documentation.

CMS’s current standard documentation guidance states that a new order/prescription is required for all claims for purchases or initial rentals, subject to the applicable DMEPOS requirements. :contentReference[oaicite:2]{index=2}

Modifier NU Examples

Practical examples for medical billers and AR callers.

Example 1 — New DME Purchase

A supplier furnishes a covered DME item to a Medicare beneficiary as new equipment and the applicable HCPCS code is eligible for purchase.

HCPCS DME

NU NEW

HCPCS-NU

The exact HCPCS code and payment rules must still be verified for the specific DME item.

Example 2 — Used Equipment

The equipment is used rather than new and the payer’s applicable rules permit purchase of used equipment.

HCPCS DME

UE USED

This is not an NU situation because NU identifies new equipment.

Example 3 — Rental

The DME is being furnished under a rental arrangement rather than as a purchase.

HCPCS DME

RR RENTAL

CMS identifies RR as the rental modifier. :contentReference[oaicite:3]{index=3}

Example 4 — New Equipment at Time of Rental

Certain circumstances can involve equipment that was new when initially rented and later purchased.

NR NEW WHEN RENTED

CMS identifies NR for an item that was new when rented and is subsequently purchased. :contentReference[oaicite:4]{index=4}

Common Modifier NU Errors

Mistakes that can lead to claim processing problems.

Using NU for Rental

NU identifies new equipment. Do not automatically use NU when the transaction is actually a rental.

Confusing NU With UE

NU identifies new equipment, while UE identifies used DME.

Ignoring HCPCS Rules

The modifier does not override the payment rules applicable to the underlying HCPCS code.

Missing Order

Required order and documentation must be obtained and maintained according to applicable DME requirements.

Assuming All DME Can Be Purchased

Some DME items are subject to rental or other payment rules. Verify the specific HCPCS code.

Ignoring Payer Policy

Commercial and government payers may have additional claim and documentation requirements.

Incorrect Equipment Status

The claim should accurately represent the status of the equipment being furnished.

Missing Delivery Evidence

Retain delivery documentation and other required supplier records.

Not Checking Current CMS Rules

DME payment, documentation and coding requirements can change. Always verify current official guidance.

AR Caller Workflow for NU Denials

Practical denial-management process.

Review ERA/EOB

Identify the exact denial and adjustment information.

Capture CARC/RARC

Record the applicable CARC and RARC information.

Review HCPCS

Confirm that the submitted HCPCS code accurately identifies the DME item.

Review NU

Determine why NU was submitted and whether it is supported.

Verify Equipment Status

Confirm that the item was actually furnished as new.

Check Purchase Rules

Determine whether the specific HCPCS item is eligible for purchase.

Review Order

Verify required order/prescription documentation.

Review Medical Necessity

Confirm the documentation supports the DME item.

Correct or Appeal

Select the appropriate next action based on the denial and supporting documentation.

AR Call Script for Modifier NU

A practical payer-call script.

“I’m calling regarding a DME claim that was submitted with the NU modifier.”

“Could you please provide the exact denial reason for the claim line?”

“Can you provide the CARC and RARC codes associated with the denial?”

“Can you confirm whether the denial is related to the NU modifier, the underlying HCPCS code, or the purchase status of the equipment?”

“Can you confirm whether this HCPCS code is eligible for purchase when reported with NU?”

“Can you confirm what documentation you require to support the new equipment status?”

“Is a corrected claim required, or can this claim be reconsidered based on the existing documentation?”

“If an appeal is required, what documentation should be included?”

“May I have the call reference number and representative ID for our records?”

Modifier NU Denial Strategy

How to determine the root cause instead of blindly resubmitting.

Modifier Denial

The payer indicates the NU modifier is invalid, inconsistent or unsupported.

HCPCS Denial

The issue may actually be with the underlying DME HCPCS code rather than NU.

Purchase Restriction

The specific item may not be payable as a purchase under the applicable Medicare rules.

Documentation Denial

The payer may require an order, medical necessity documentation or proof of delivery.

Eligibility Denial

Verify beneficiary eligibility and DME benefit coverage for the date of service.

Payer-Specific Edit

Review the payer’s current DME billing and documentation instructions.

Should You Use Modifier NU?

Simple decision workflow.

1 Is the claim for a DME/DMEPOS item?

2 Is the HCPCS code correctly identified?

3 Is the equipment actually new?

4 Is the applicable transaction a purchase rather than a rental?

5 Does the specific HCPCS item allow the applicable purchase arrangement?

6 Are the required order and documentation available?

7 Does the payer require any additional documentation or authorization?

8 If applicable, submit the HCPCS code with NU.

9 Monitor the claim and investigate any denial.

Important Medicare Points

NU does not by itself guarantee Medicare payment.

Coverage Still Matters

The DME item must satisfy applicable Medicare coverage and benefit requirements.

Medical Necessity Still Matters

Reporting NU does not establish medical necessity. Supporting documentation is still required.

Purchase Rules Still Matter

Some DME items are subject to specific rental, purchase or payment restrictions.

Documentation Still Matters

Required orders and records must be maintained according to applicable DME requirements.

HCPCS Still Matters

NU cannot correct an incorrectly selected HCPCS code.

Payer Rules Still Matter

Always check the applicable Medicare contractor or payer requirements.

Current CMS DME Resources

Use official CMS resources when verifying DME claims.

CMS — Overview of Coding & Classification Systems CMS explains that HCPCS modifiers provide additional information about the item or service and specifically gives NU as the modifier for new equipment. :contentReference[oaicite:5]{index=5} CMS — Medicare Claims Processing Manual, Chapter 20 CMS DME claims-processing guidance lists NU as “New equipment,” RR as rental and NR for new equipment when rented and subsequently purchased. :contentReference[oaicite:6]{index=6} CMS — DMEPOS Current CMS DMEPOS resource containing DMEPOS fee schedules, coding information, DME MAC resources and related Medicare guidance. :contentReference[oaicite:7]{index=7} CMS — Standard Documentation Requirements for DME MAC Claims CMS documentation guidance addressing orders, prescriptions and documentation requirements for DMEPOS claims. :contentReference[oaicite:8]{index=8} CMS — Medicare NCCI MUEs CMS publishes DME Supplier Services MUE files and updates them quarterly. :contentReference[oaicite:9]{index=9}

Important Billing Disclaimer

Modifier NU identifies new equipment, but its presence does not independently establish Medicare coverage, medical necessity, correct coding, purchase eligibility or payment. Always verify the specific HCPCS code, applicable Medicare policy, DME MAC requirements and payer-specific rules before billing or appealing.

Modifier NU FAQs

What does Modifier NU mean?

NU means new equipment. CMS uses NU to identify DME as new equipment. :contentReference[oaicite:10]{index=10}

Is NU used for DME purchases?

CMS claims-processing guidance identifies NU as the modifier for purchase of new equipment, subject to the specific item’s applicable payment rules. :contentReference[oaicite:11]{index=11}

What is the difference between NU and UE?

NU identifies new equipment, while UE identifies used durable medical equipment. :contentReference[oaicite:12]{index=12}

What is the difference between NU and RR?

NU identifies new equipment. RR identifies rental. The appropriate modifier depends on the transaction and applicable HCPCS/payment rules. :contentReference[oaicite:13]{index=13}

Does NU guarantee Medicare payment?

No. NU only provides information about the equipment. Coverage, medical necessity, coding, documentation, payment rules and other requirements still apply.

Is a new order required for a DME purchase?

CMS’s standard DME documentation guidance states that a new order/prescription is required for all claims for purchases or initial rentals, subject to the applicable DMEPOS requirements. :contentReference[oaicite:14]{index=14}

Can NU be used for every DME item?

Do not assume that. The specific HCPCS code and its applicable Medicare payment rules must be reviewed. Some items have specific purchase or rental requirements.

What should an AR caller check when NU is denied?

Review the ERA/EOB, CARC/RARC, HCPCS code, NU modifier, equipment status, purchase eligibility, order, medical necessity documentation, delivery records and payer-specific DME requirements.

What is NR?

CMS identifies NR for an item that was new when rented and is subsequently purchased. :contentReference[oaicite:15]{index=15}

Where can Modifier NU be verified?

CMS’s HCPCS coding information and Medicare Claims Processing Manual identify NU as the modifier for new equipment. :contentReference[oaicite:16]{index=16}

      
        Modifier NU Quick Cheat Sheet
      
        NU = New equipment.
      
        NU is an HCPCS Level II modifier.
      
        NU provides additional information about the DME item.
      
        NU is associated with applicable purchase claims for
        new equipment.
      
        UE = Used durable medical equipment.
      
        RR = Rental.
      
        NR = New when rented and subsequently purchased.
      
        Do not use NU to override HCPCS-specific payment rules.
      
        Verify whether the specific item can be purchased.
      
        Verify the treating practitioner’s order requirements.
      
        Verify medical necessity.
      
        Maintain delivery documentation.
      
        Check payer-specific DME requirements.
      
        Review CARC/RARC when NU claims deny.
      
        Correct or appeal based on the actual root cause.

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