Durable Medical Equipment (DME) plays an essential role in patient care by providing medically necessary equipment that can withstand repeated use and is intended for home use. Medicare Part B covers many types of DME, such as wheelchairs, walkers, hospital beds, oxygen equipment, and CPAP devices, when coverage requirements are met.

One of the most important modifiers used in DME billing is Modifier NU, which indicates that the supplier is furnishing new durable medical equipment as a purchase, rather than renting the equipment or providing a used item.

Correct use of Modifier NU helps Medicare and other insurers identify the payment category, apply the appropriate reimbursement methodology, and distinguish purchased equipment from rental or used equipment.

Modifier

Modifier Name

New Durable Medical Equipment Purchase

Plain English Explanation

Modifier NU tells the insurance payer:

“The supplier is providing a brand-new piece of durable medical equipment that is being purchased.”

It confirms that the equipment has never been previously owned or used and is not being rented.

Purpose of Modifier NU

Modifier NU is used to:

Identify newly purchased DME.
Distinguish new equipment from rental equipment.
Distinguish new equipment from used equipment.
Ensure correct Medicare reimbursement.
Support accurate DMEPOS claim processing.
Comply with CMS billing requirements.

Understanding Modifier NU

Medicare classifies many DME items into different payment categories.

Modifier NU indicates the supplier is furnishing:

A new item.
A purchased item.
Equipment that has not previously been issued to another beneficiary.

It should not be confused with:

Modifier	Meaning
NU	New equipment purchase
UE	Used equipment purchase
RR	Rental equipment
RA	Replacement of DME item
RB	Replacement of a part furnished during repair

When to Use Modifier NU

Use Modifier NU when:

A new DME item is sold to the patient.
Medicare allows the equipment to be purchased.
The HCPCS code requires reporting the purchase.
The equipment has never been previously used.
Documentation supports the purchase.

Examples include:

Walkers
Wheelchairs (when purchase is appropriate)
Hospital beds (purchase category, when applicable)
Nebulizers
CPAP devices (when payer policy allows purchase)
Commode chairs
Patient lifts
Infusion pumps (depending on coverage rules)

When NOT to Use Modifier NU

Do not use Modifier NU when:

Equipment is rented (use RR).
Used equipment is purchased (use UE).
A replacement item is being billed (use RA, when appropriate).
Only a repair part is furnished (use RB).
Medicare requires rental rather than purchase for that specific item.

Medicare Rules

Under Medicare:

Modifier NU identifies new purchased DME.
It is commonly used with Inexpensive or Routinely Purchased (IRP) DME items when billing a purchase.
Coverage depends on:
- Medical necessity.
- Physician order.
- Medicare-approved supplier.
- HCPCS code payment category.
- Applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD).

Some DME items are purchase only, while others are rental only or allow the beneficiary to choose between rental and purchase. Medicare payment rules vary by HCPCS code.

Commercial Insurance Rules

Many commercial insurers follow Medicare DME billing standards.

However, payer-specific policies may differ regarding:

Purchase versus rental requirements.
Prior authorization.
Medical necessity.
Frequency limitations.
Replacement intervals.
Modifier sequencing.

Always verify payer-specific DME billing policies before claim submission.

Documentation Requirements

Documentation should include:

Physician order or prescription.
Face-to-face evaluation, when required.
Medical necessity documentation.
HCPCS code.
Modifier NU.
Delivery ticket.
Proof of delivery.
Supplier invoice (when required).
Beneficiary acknowledgment.
Serial number or manufacturer information, when applicable.

Real Billing Examples

Example 1 – New Walker Purchase

A physician orders a brand-new standard walker for a patient following hip replacement surgery.

Billing

HCPCS E0135
Modifier NU

Example 2 – New CPAP Device

A patient with obstructive sleep apnea receives a new CPAP device that is payable as a purchase under the applicable payer policy.

Billing

HCPCS E0601
Modifier NU (only if the payer’s payment rules permit purchase; Medicare often treats E0601 under a capped rental methodology rather than an outright purchase).

Example 3 – New Commode Chair

A supplier furnishes a brand-new bedside commode.

Billing

HCPCS E0163
Modifier NU

Example 4 – New Nebulizer

A beneficiary receives a newly purchased nebulizer.

Billing

HCPCS E0570
Modifier NU

Example 5 – Incorrect Use

A supplier bills:

E0135-RR

when the equipment was actually sold.

This is incorrect because RR indicates rental, while NU identifies a new purchased item.

CMS-1500 Claim Example

Field	Example
HCPCS	E0135
Modifier	NU
Diagnosis Pointer	Appropriate ICD-10-CM diagnosis
Units	1

Common Denial Reasons

Incorrect modifier.
NU billed on a rental-only item.
Missing physician order.
Missing proof of delivery.
Medical necessity not established.
Prior authorization missing (when required).
Incorrect HCPCS code.
Invalid modifier combination.

How to Correct the Denial

Verify the HCPCS payment category.
Confirm the equipment was purchased.
Review the physician order.
Verify proof of delivery.
Confirm medical necessity.
Correct the modifier if necessary.
Resubmit the claim or file an appeal with supporting documentation.

Coding Tips

Always verify whether the equipment is purchase, rental, or capped rental.
Never use NU for used equipment.
Review DME MAC guidance before billing.
Keep complete proof-of-delivery records.
Ensure the modifier matches the payment methodology.

Modifier NU vs Modifier RR

Modifier	Description
NU	New equipment purchase
RR	Rental equipment

Modifier NU vs Modifier UE

Modifier	Description
NU	New equipment purchase
UE	Used equipment purchase

Modifier NU vs Modifier RA

Modifier	Description
NU	New equipment purchase
RA	Replacement of DME item

Modifier NU vs Modifier RB

Modifier	Description
NU	New equipment purchase
RB	Replacement of a part during repair

Frequently Asked Questions (FAQs)

Q1. What does Modifier NU mean?

Answer: It indicates that the supplier furnished new durable medical equipment as a purchase.

Q2. Can Modifier NU be used for rented equipment?

Answer: No. Rental equipment should generally be billed with Modifier RR, not NU.

Q3. What is the difference between NU and UE?

Answer: NU is for new equipment, while UE is for used equipment.

Q4. Is Modifier NU required on every DME claim?

Answer: No. It is used only when the applicable HCPCS code and payer policy require identification of a new purchased item.

Q5. Can Modifier NU be used with Medicare?

Answer: Yes. Medicare recognizes Modifier NU for qualifying DME purchases, subject to the payment category and coverage rules for the specific HCPCS code.

AR Caller Tips

When following up on DME claim denials:

Confirm whether the equipment was purchased or rented.
Verify the HCPCS payment category.
Review proof of delivery.
Verify physician documentation.
Check prior authorization status, if required.
Confirm modifier sequencing.
Document the payer representative’s name, reference number, and appeal instructions.

Interview Questions

Question 1

What does Modifier NU represent?

Answer: New durable medical equipment purchase.

Question 2

What modifier is used for rented DME?

Answer: RR.

Question 3

What is the difference between NU and UE?

Answer: NU identifies a new purchased item, while UE identifies a used purchased item.

Question 4

Can Modifier NU be reported on every DME item?

Answer: No. Its use depends on the HCPCS code, the item’s payment category, and payer-specific billing rules.

Practice Scenario

Scenario

A Medicare supplier furnishes a brand-new walker that qualifies as a purchased DME item. The physician has provided a valid order, and proof of delivery is available.

Question

Which modifier should be reported?

Answer

Modifier NU should be appended to the appropriate HCPCS code because the equipment is new and purchased.

Related DME Modifiers

RR – Rental
UE – Used Durable Medical Equipment Purchase
RA – Replacement of DME Item
RB – Replacement of a Part of a DME Item During Repair
NR – New Equipment at Time of Rental (Purchased After Rental Period)
KH – Initial Claim for First Rental Month
KI – Second or Third Rental Month
KJ – Fourth Through Fifteenth Rental Month

Common Billing Mistakes

Billing NU for rental equipment.
Using NU for used equipment.
Missing proof of delivery.
Billing purchase when the item is classified as capped rental.
Missing physician documentation.
Incorrect HCPCS code selection.
Using incompatible modifier combinations.

Key Takeaways

Modifier NU indicates new durable medical equipment purchased by the beneficiary or payer.
It distinguishes new purchases from rentals (RR) and used purchases (UE).
Always verify the HCPCS payment category before billing.
Complete documentation—including physician orders, proof of delivery, and medical necessity—is essential.
Correct use of Modifier NU helps reduce DME claim denials and ensures proper reimbursement.

References

Medicare DME Coverage Guidance.
Noridian DME Modifier NU Guidance.
CMS State Fee Schedule Modifier Reference (NU – New Durable Medical Equipment Purchase).
CMS Medicare Claims Processing Manual (DMEPOS).
HCPCS Level II Code Book.

Conclusion

Modifier NU is one of the most frequently used modifiers in DME billing because it identifies a brand-new purchased item. Correct application requires understanding the DME payment category, confirming that the equipment is new rather than rented or used, and maintaining complete supporting documentation. Proper use of Modifier NU promotes Medicare compliance, accurate reimbursement, and fewer claim denials.

Educational Disclaimer

This article was prepared with the assistance of artificial intelligence (AI) for educational and informational purposes. It is based on publicly available CMS guidance, Medicare DMEPOS billing principles, and general medical coding practices. It is not an official publication of CMS or the American Medical Association (AMA). Always consult the latest CMS Medicare Claims Processing Manual, HCPCS Level II codebook, DME Medicare Administrative Contractor (DME MAC) guidance, Local Coverage Determinations (LCDs), and payer-specific billing policies before coding, billing, or submitting claims.