Modifier RR
Rental Durable Medical Equipment
Learn what Modifier RR means, when it is used for DME rental claims, how it differs from purchase modifiers, and how AR callers can troubleshoot rental-related denials.
Modifier RR at a Glance
The essential points for DME billers, AR callers and medical billing professionals.
Rental
CMS defines RR as the modifier used when DME is to be rented.
DME Claims
RR is appended to the applicable DME HCPCS code when the item is billed as a rental.
Monthly Billing
Many rental arrangements involve recurring claim lines, although payment methodology depends on the specific DME category.
Not a Purchase
NU identifies new equipment for applicable purchases; RR identifies rental.
What Is Modifier RR?
A simple explanation for beginners and experienced billing professionals.
Official Meaning
CMS identifies:
CMS instructs suppliers to use the RR modifier when DME is to be rented.
The modifier communicates the rental status of the DME service represented by the HCPCS code.
Plain-English Explanation
Think of RR as:
“This DME item is being furnished as a rental.”
The HCPCS code identifies the DME item. RR provides additional information that the item is being billed under a rental arrangement.
Key Point
RR tells the payer that the DME is being rented. It does not, by itself, prove that the item is covered, medically necessary, or payable.
How Modifier RR Works
Follow the complete DME rental billing logic.
Identify the DME
Determine the exact DME item and select the appropriate HCPCS Level II code.
Determine Rental Status
Confirm that the transaction is being furnished under a rental arrangement.
Verify Rental Rules
Check the applicable Medicare or payer rules for that specific HCPCS item.
Check Documentation
Verify the order, medical necessity documentation and other required records.
Verify Authorization
Determine whether prior authorization or other payer requirements apply.
Submit Rental Claim
Submit the appropriate HCPCS code with RR when applicable.
RR vs NU vs UE
Understand the difference between rental and purchase modifiers.
| Modifier | Meaning | Transaction | Equipment Status |
|---|---|---|---|
| RR | Rental | Rental | Equipment is being rented |
| NU | New equipment | Purchase | New equipment |
| UE | Used durable medical equipment | Purchase | Used equipment |
| NR | New when rented | Subsequently purchased | New at the time of rental |
Important
Do not select RR simply because the supplier has an equipment rental program. The actual beneficiary transaction, HCPCS-specific rules and payer requirements must support rental billing.
Easy Way to Remember the DME Modifiers
RR — Rental
Think: “Rent the DME.”
NU — New Equipment
Think: “Purchase new DME.”
UE — Used DME
Think: “Purchase used DME.”
Modifier RR Billing Workflow
Step-by-step workflow for DME billing teams.
Medicare DME Rental Concepts
RR is only one part of DME rental billing.
Initial Rental
Certain DME rental claims have specific initial-month requirements and may use additional modifiers such as KH depending on the item and circumstances.
Subsequent Rental Months
Certain rental categories use additional modifiers to identify subsequent rental months, such as KI or KJ where applicable.
Capped Rental
Some DME categories are subject to capped rental rules and a defined period of continuous use.
Inexpensive DME
Certain inexpensive or routinely purchased DME has specific Medicare payment methodology.
Oxygen Equipment
Oxygen and oxygen equipment have separate Medicare payment and rental rules.
Item-Specific Rules
Always verify the specific HCPCS code and applicable Medicare DMEPOS policy before billing.
Why This Matters
CMS’s claims-processing guidance identifies RR as rental, but DME rental payment can vary by category. For example, CMS describes specific payment methodologies for inexpensive/routinely purchased DME and capped rental equipment.
Important DME Rental Modifiers
RR may appear with other DME status modifiers depending on the claim circumstances.
| Modifier | General Meaning | Billing Concept |
|---|---|---|
| RR | Rental | DME is being rented. |
| KH | Initial claim / purchase or first month rental | Applicable DMEPOS rental circumstances. |
| KI | Second or third month rental | Applicable rental categories. |
| KJ | PEN pump or capped rental months four through fifteen | Applicable DMEPOS rental circumstances. |
| BR | Beneficiary elected rental | Purchase/rental option notification requirement. |
| BP | Beneficiary elected purchase | Purchase/rental option notification requirement. |
| BU | Beneficiary has not made a decision after 30 days | Purchase/rental option notification requirement. |
Modifier requirements vary by item and circumstance. The CMS Claims Processing Manual should be checked for the specific DME category and current billing instructions.
DME Rental Documentation Checklist
A strong rental claim starts with complete documentation.
- Beneficiary identification.
- Valid treating practitioner order/prescription when required.
- Order date.
- Description of the DME item.
- Appropriate HCPCS code.
- Quantity when applicable.
- Medical necessity documentation.
- Face-to-face or other encounter documentation when required.
- Prior authorization documentation when required.
- Proof of delivery.
- Rental agreement or supplier documentation when applicable.
- Evidence supporting continued use when required.
- Documentation of equipment delivery and possession.
- Applicable payer-specific documentation.
Modifier RR Real-World Examples
Practical scenarios for medical billing and AR teams.
A supplier furnishes a covered DME item to a Medicare beneficiary under a rental arrangement.
The applicable HCPCS code is submitted with RR when required by the applicable billing rules.
A supplier sells a new DME item rather than renting it.
RR would not represent the transaction because this example is a purchase rather than a rental.
The equipment is furnished as a purchase and is used equipment.
RR would not describe this transaction because it is a purchase.
Equipment is new when initially rented and is later purchased under applicable Medicare rules.
CMS identifies NR for an item that was new at the time of rental and is subsequently purchased.
Common Modifier RR Errors
Mistakes that can create DME rental claim problems.
Using RR for a Purchase
RR identifies rental. Do not use it to represent a purchase transaction.
Ignoring Rental Month
Some DME categories require additional modifiers to identify the rental month.
Wrong HCPCS Code
RR cannot correct an incorrectly selected DME HCPCS code.
Missing Order
Required orders and prescriptions must be obtained and maintained according to applicable requirements.
Missing Proof of Delivery
Supplier records should support delivery and receipt of the equipment when required.
Ignoring Continued Need
Certain rental categories have documentation and continued-use requirements.
Missing Authorization
Some items or payers may require prior authorization before rental.
Ignoring Payer Rules
Commercial and government payers can have additional DME rental requirements.
Assuming RR Guarantees Payment
RR identifies rental status but does not establish coverage or medical necessity.
AR Caller Workflow for RR Denials
Use the denial code to find the actual root cause.
Review ERA/EOB
Identify the exact denial and adjustment information.
Capture CARC/RARC
Document the CARC and RARC associated with the denial.
Verify HCPCS
Confirm that the DME HCPCS code is correct.
Verify RR
Determine whether the claim was correctly submitted as a rental.
Check Rental Month
Determine whether KH, KI, KJ or another applicable modifier is required.
Check Coverage
Confirm the DME item is covered for the beneficiary.
Check Documentation
Verify order, medical necessity and delivery documentation.
Call Payer
Obtain the exact denial reason and correction requirements.
Correct or Appeal
Select the correct action based on the root cause.
AR Call Script for Modifier RR
Practical payer-call language.
“I’m calling regarding a DME rental claim that was submitted with the RR modifier.”
“Could you please provide the exact denial reason for this claim line?”
“Can you provide the CARC and RARC codes associated with the denial?”
“Can you confirm whether the denial is related to the RR modifier, the HCPCS code, the rental month or the patient’s DME benefit?”
“Can you confirm the correct rental modifier combination required for this HCPCS code?”
“Can you confirm whether prior authorization is required?”
“Can you confirm whether the claim requires additional documentation such as the order, medical necessity records or proof of delivery?”
“Would this require a corrected claim or a formal appeal?”
“May I have the call reference number and representative ID for our records?”
RR Denial Root-Cause Analysis
Do not automatically resubmit a denied rental claim.
Modifier Error
The payer may determine that RR is incorrect or that another rental-status modifier is required.
Rental Month Error
The claim may have the wrong modifier for the current rental month.
HCPCS Error
The underlying DME code may be incorrect or not appropriate for the billed item.
Coverage Error
The patient’s benefit may not cover the item or the particular rental arrangement.
Medical Necessity
Documentation may not support Medicare’s or the payer’s medical necessity requirements.
Authorization
The required authorization may be missing or invalid.
Should You Use Modifier RR?
Simple DME rental decision workflow.
Medicare Rental Payment Concepts
Why the rental category matters.
Capped Rental
Certain DME categories are subject to capped rental rules. Medicare describes a period of continuous use for certain capped rental equipment.
The number of rental months, continued use and payment rules depend on the specific DME category.
Inexpensive / Routinely Purchased DME
CMS has specific payment methodology for inexpensive or routinely purchased DME.
Never assume that all RR claims follow the same payment calculation.
Verify the Specific HCPCS
CMS payment methodology can differ by DME category. Always verify the specific HCPCS code, applicable DME MAC policy and current Medicare payment rules before determining the correct rental billing strategy.
Common AR Scenarios
What an experienced AR caller should investigate.
RR Denied as Invalid Modifier
Verify whether the HCPCS code requires RR and whether another modifier is required for the specific rental month.
Rental Not Covered
Verify the beneficiary’s DME benefit, coverage policy, HCPCS code and medical necessity.
Missing Documentation
Review the order, medical records, proof of delivery and other documentation requested by the payer.
Prior Authorization Missing
Verify whether authorization was required and whether the authorization matched the HCPCS code and dates.
Duplicate Rental
Compare previous paid and billed rental months before submitting another claim.
Incorrect Rental Month
Review the patient’s rental history and determine whether the appropriate month-specific modifier was submitted.
Modifier RR Quick Cheat Sheet
- RR = Rental.
- RR is used when DME is to be rented.
- RR is appended to the applicable DME HCPCS code.
- RR does not mean the claim is automatically payable.
- Verify the specific HCPCS rental rules.
- Check whether an additional rental-month modifier is required.
- KH may identify an initial claim/first rental month when applicable.
- KI may identify the second or third rental month when applicable.
- KJ may apply to certain capped rental/PEN pump months when applicable.
- BR indicates beneficiary elected rental after being informed of purchase/rental options.
- NU = New equipment purchase.
- UE = Used DME purchase.
- NR = New when rented and subsequently purchased.
- Verify order and medical necessity.
- Maintain proof of delivery and required supplier documentation.
- Check payer-specific DME policies.
Official CMS Resources
Use primary sources when verifying DME rental claims.
Billing Disclaimer
Modifier RR identifies rental status. It does not independently establish coverage, medical necessity, authorization, correct coding or payment. Always verify the specific HCPCS code, Medicare policy, DME MAC requirements and payer-specific rules before billing or appealing.
Modifier RR FAQs
What does Modifier RR mean?
RR means Rental. CMS instructs suppliers to use the RR modifier when DME is to be rented.
What is Modifier RR used for?
RR is used on applicable DME claims to identify that the equipment is being furnished as a rental.
Is RR used with a HCPCS code?
Yes. The applicable DME HCPCS code is reported with the RR modifier when the item is being rented and the applicable billing rules require it.
Is RR the same as NU?
No. RR identifies rental. NU identifies new equipment for applicable purchase claims.
Is RR the same as UE?
No. UE identifies used durable medical equipment, while RR identifies rental.
Does RR mean the DME is automatically covered?
No. Coverage, medical necessity, correct coding, documentation, authorization and other payment requirements still apply.
Does every rental claim only need RR?
Not necessarily. Certain DME categories can require additional modifiers that identify the rental month or other claim circumstances. Verify the specific HCPCS and current payer instructions.
What is KH?
CMS identifies KH for a DMEPOS item’s initial claim, purchase or first month rental, subject to the applicable rules. CMS has also specified circumstances where KH is no longer required for certain purchased claims.
What is KI?
CMS identifies KI for the second or third month of rental for applicable DMEPOS claims.
What is KJ?
CMS identifies KJ for certain PEN pump or capped rental months four through fifteen.
What should an AR caller check when RR is denied?
Review the ERA/EOB, CARC/RARC, HCPCS code, RR modifier, rental month, DME benefit, order, medical necessity, authorization, proof of delivery and payer-specific requirements.
Can DME rental continue indefinitely?
Not necessarily. Certain Medicare DME categories are subject to defined rental or capped-rental rules. The applicable period depends on the equipment category and current Medicare payment policy.
Where can Modifier RR be verified?
The primary source is the CMS Medicare Claims Processing Manual, Chapter 20, which identifies RR as the rental modifier for DME.
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