Claims, prior authorization, rental tracking and denial recovery for HME and DME suppliers, respiratory and sleep equipment providers, diabetes supply companies, orthotics and prosthetics providers and practices that dispense.
DME revenue repeats every month, so one billing error repeats with it: a rental month sent with the wrong modifier, a wheelchair shipped before prior authorization, a CPAP resupply shipped 12 days before the old supply runs out, or a delivery with no proof the patient received it. Medicare denies or recoups each one. Luxen runs full-service medical billing for DME suppliers inside the software you already use, with certified coders and a BAA signed before we touch a claim.
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DME billing services handle claims for durable medical equipment suppliers: orders, prior authorization, rental month modifiers, proof of delivery, resupply and denials. Medicare pays most capped rentals for 13 months and oxygen equipment for 36, and proof of delivery was missing on 14% of DME audit requests (Luxen claim audit).
Medicare DME claims go to four DME MACs, but the rules that deny them change by product line and supplier type.
We bill rentals, purchases, supplies, oxygen contents, repairs and maintenance to Medicare, Medicaid, Medicare Advantage and commercial plans.
DME losses compound: a modifier error in month 4 can repeat through month 13, and a missing delivery record can pull back claims that already paid. Missing or invalid prior authorization caused 17% of denials across our audits (Luxen claim audit), and DME adds rental, oxygen and refill rules on top. Our denials and AR recovery team works the oldest rental months first.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Capped rental month count | E0601, E0260, K0001 with RR and KH, KI or KJ | KH billed again in month 2, or KI carried past month 3 | Months 4 to 13, which is 10 of 13 rental payments | The wrong KH, KI or KJ modifier appeared on 7% of capped rental months (Luxen claim audit) |
| Prior authorization item | K0856, L1851, E0277, L5856 | Shipped before a provisional affirmation, so the claim has no UTN | The full claim, automatically denied | Claims sent without a prior authorization UTN made up 11% of DME denials (Luxen claim audit) |
| Proof of delivery | A7030, A4239 shipped with KL | Direct delivery dated by the ship date, or no tracking link to the invoice | Every paid claim in an audit sample, recouped | Proof of delivery was missing on 14% of DME audit requests (Luxen claim audit) |
| Early refill | A7030, A7037, A4239 | Refill contact outside the 30-day window, or shipment more than 10 days before the current supply ends | Each resupply month billed | Refill timing and refill request errors caused 13% of DME supply denials (Luxen claim audit) |
| Oxygen past month 36 | E1390, E0431, E0443 | Equipment rental billed after the cap, or an MS visit billed too early | All equipment rental after month 36; the CY 2026 MS fee is $89.58 per visit | Coding and modifier errors caused 21% of denials (Luxen claim audit) |
Medicare DME claims go in electronically as ASC X12 837P files through CEDI, the single front end for all four DME MACs.
| Jurisdiction | Contractor | States |
|---|---|---|
| A | Noridian | CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT |
| B | CGS | IL, IN, KY, MI, MN, OH, WI |
| C | CGS | AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, PR, USVI |
| D | Noridian | AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY and Pacific territories |
In Idaho, Noridian also runs the Jurisdiction F A/B MAC, so a practice that dispenses works one contractor on both sides of the claim.
Medicare pays capped rental items such as CPAP devices and hospital beds for 13 continuous months. On the first day after month 13, the supplier must transfer title to the beneficiary (42 CFR 414.229).
| Rental month | Modifiers | Billing note |
|---|---|---|
| 1 | RR, KH | First month of the rental |
| 2 and 3 | RR, KI | Second and third months |
| 4 to 13 | RR, KJ | Billing stops after month 13 |
| After 13 | None for rental | Repairs are payable; routine servicing is not |
Oxygen equipment rental stops after 36 months (42 CFR 414.226), but the supplier keeps furnishing it for the rest of the 5-year useful lifetime. After month 36, Medicare pays contents for gaseous and liquid systems, nothing for concentrators, and a maintenance and servicing (MS) visit for concentrators and transfill equipment no more often than every 6 months. The CY 2026 MS fee is $89.58.
| Modifier | Meaning |
|---|---|
| NU, UE, RR | New purchase, used purchase, rental |
| KX | Medical policy requirements met |
| GA | Valid ABN (form CMS-R-131) on file |
| GZ | Expected denial, no ABN; denied automatically |
| KL | Delivered by mail |
| RA | Replacement for a lost, stolen or irreparably damaged item |
Patients owe 20% coinsurance after the $283 Part B deductible in 2026, and each rental month creates a new balance. Our medical coding team checks modifier pairs against each policy article, and our patient billing team handles the monthly statements.
Since January 1, 2020, one order type covers DMEPOS claims. Under 42 CFR 410.38 it needs the beneficiary name or MBI, a general description of the item, quantity if applicable, the order date, the treating practitioner name or NPI, and the practitioner signature. For most items the order must reach the supplier before the claim goes out. For power mobility devices and items on the Required Face-to-Face Encounter and Written Order Prior to Delivery List, it must arrive before delivery, with a face-to-face encounter in the 6 months before the order.
| Category | Codes | Required since |
|---|---|---|
| Power mobility | Selected K0813 to K0864; K0800 to K0802, K0806 to K0808 | 2017 to 2022 |
| Pressure reducing support surfaces | E0193, E0277, E0371, E0372, E0373 | October 21, 2019 |
| Lower limb prostheses | L5856, L5857, L5858, L5973, L5980, L5987 | December 1, 2020 |
| Orthoses | L0648, L0650, L1832, L1851; L0631, L0637, L0639, L1843, L1845, L1951 | 2022 and 2024 |
| Orthoses and compression devices | L0651, L1844, L1846, L1852, L1932, E0651, E0652 | April 13, 2026 |
The DME MAC decides within 5 business days of a complete request or resubmission and tries to decide expedited requests within 2 business days. A claim for a listed code without a UTN is automatically denied. Our eligibility and prior authorization team files the request and holds the ship date until the affirmation posts.
| Delivery method | Required elements | Date of service |
|---|---|---|
| Supplier delivers directly | Beneficiary name, delivery address, item description, quantity, date delivered, beneficiary or designee signature | Date the beneficiary received the item |
| Shipping or delivery service | Beneficiary name, delivery address, package ID or invoice number linked to carrier records, item description, quantity, date delivered, evidence of delivery | Shipping date or delivery date |
Keep delivery and order records for 7 years from the date of service.
E0601 is paid as a 13-month capped rental. Coverage past the first 3 months needs use of 4 or more hours per night on 70% of nights in a consecutive 30-day period, documented at a re-evaluation between day 31 and day 91 (LCD L33718). A7030 full face masks, A7034 nasal masks and A7037 tubing are each allowed 1 per 3 months.
LCD L33822 covers CGMs for insulin-treated diabetes or a history of problematic hypoglycemia, with a practitioner visit in the 6 months before the order and every 6 months after. Bill E2103 with the A4239 monthly supply allowance for a non-adjunctive CGM, and E2102 with A4238 for an adjunctive CGM that needs a fingerstick check before treatment decisions. Each supply allowance bills as 1 unit per month.
Group I qualifies with an arterial PO2 at or below 55 mm Hg or saturation at or below 88% (NCD 240.2); Group II covers 56 to 59 mm Hg or 89% with qualifying conditions (LCD L33797). CMNs ended for dates of service from January 1, 2023, and since April 13, 2026, oxygen equipment such as E1390 needs a face-to-face encounter and a written order before delivery.
A power mobility product can be billed under its specific K code only if the PDAC has issued a coding verification review; otherwise it bills as K0899 (Article A52498). Many power wheelchairs also need prior authorization and a face-to-face encounter before the order.
Contact the beneficiary within 30 calendar days of the expected end of the current supply, and ship no sooner than 10 calendar days before it runs out (Program Integrity Manual, chapter 5). Both dates belong in the claim file. A medical virtual assistant can run refill calls and log each response.
The rule: since January 1, 2024, contact must fall within 30 calendar days of the expected end of the current supply, with delivery no sooner than 10 days before it ends. The cost: suppliers still on the old window miss refills, and early shipments deny for the full month billed. Luxen audit: Refill timing and refill request errors caused 13% of DME supply denials (Luxen claim audit).
The rule: under Standard Documentation Requirements article A55426, the ship date works only for items sent through a delivery service with a tracking link; direct deliveries use the date the beneficiary received the item. The cost: claims fail proof of delivery review and are recouped. Luxen audit: Proof of delivery was missing on 14% of DME audit requests (Luxen claim audit).
The rule: a new 36-month period starts only after the 5-year useful lifetime ends or after loss, theft or irreparable damage (DME MAC oxygen payment rules). The cost: rental months billed past the cap deny, while service is still owed through year 5. Luxen audit: Coding and modifier errors caused 21% of denials (Luxen claim audit).
The rule: claims for listed codes without a prior authorization decision and UTN are automatically denied. The cost: the entire claim, with the equipment already in the home. Luxen audit: Missing or invalid prior authorization caused 17% of denials (Luxen claim audit).
The rule: DME furnished during a covered Part A SNF or hospital stay is included in the facility payment (Claims Processing Manual, chapter 20). The cost: the claim denies, or pays and is recouped later. Luxen audit: Eligibility and coverage errors caused 24% of denials (Luxen claim audit).
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
DME billing runs across intake, delivery, compliance data and DME MAC portals. We work inside the systems you already use, with no migration:
Each week we match delivery records in your platform to the claims that went out.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Orders were shipping before proof of delivery and supporting documentation reached billing. Luxen introduced a shipment-to-claim checklist, reduced documentation denials from 22% to 6%, and recovered $91,500.
Operations Director, regional durable medical equipment supplier
Recurring supply claims stopped whenever an order or certification expired, but our team often noticed months later. Luxen built a renewal calendar that reduced interrupted resupply accounts by 84%.
Revenue Cycle Manager, respiratory equipment provider
Full engagements are written up in our dental practice case study and our ambulance billing case study.
2026 added codes to both documentation lists, raised accreditation survey frequency and set the next competitive bidding round. Each change adds a hold or a check before claims go out.
| Date | Change | Billing impact |
|---|---|---|
| January 1, 2026 | DMEPOS fee schedule update factor of 2.0% | Update expected payment tables |
| January 1, 2026 | Accreditation organizations resurvey suppliers at least every 12 months instead of every 3 years | Keep survey files current all year |
| April 13, 2026 | Oxygen codes E0424, E0431, E0433, E0434, E0439, E1390, E1391 and E1392 join the face-to-face and written order list | Hold delivery until the encounter note and order arrive |
| October 28, 2026 | Prior authorization for E0194, K0005, L0456, L0457, L0486 and L1833; face-to-face and order before delivery for E1161, K0002 to K0007, K0738, K0831 and more | New holds on common wheelchairs and braces |
| October 28, 2026 to April 26, 2027 | Prior authorization for L3761 and L3916 starts in NY, MI, FL and CA, then goes nationwide | Upper limb orthoses need tracking by state |
| Late fall 2026 (CMS target) | Round 2028 bidding: CGMs and insulin pumps, urological and ostomy supplies, hydrophilic catheters, off-the-shelf back, knee and upper extremity braces, in one nationwide remote item delivery area | Contracts start no later than January 1, 2028 |
The CY 2026 home health final rule also moves CGMs and insulin pumps in that round to bundled monthly rental payment. Medicaid shifts too: in South Carolina, the January 2026 managed care carve-in moved DME for affected adults into health plans. Medicare revalidation still falls every 3 years, and our credentialing team tracks it alongside reaccreditation.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, month to month, with no setup or exit fee. Example: a DME supplier collecting $150,000 a month.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% | In-house at 7.9% |
|---|---|---|---|---|
| Capped rentals (CPAP, beds, wheelchairs) | $45,000 | $1,350 | $2,700 | $3,555 |
| Oxygen equipment and contents | $35,000 | $1,050 | $2,100 | $2,765 |
| Resupply (PAP and CGM supplies) | $55,000 | $1,650 | $3,300 | $4,345 |
| Purchased items and orthoses | $15,000 | $450 | $900 | $1,185 |
| Total | $150,000 | $4,500 | $9,000 | $11,850 |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews), or $11,850 a month here. Your rate within the range depends on rental and resupply volume and how many items need prior authorization. In-house teams also carry vacancy risk: open biller roles took a median 67 days to fill (Luxen Practice Manager Survey 2026).
| Partner type | DME MAC rule depth | Rentals and resupply | Works in your systems | Cost basis |
|---|---|---|---|---|
| In-house team | One or two billers | Manual calendars | Yes | Salaries and software |
| Generalist billing company | Physician claims focus | Often not tracked | Sometimes | Percent of collections |
| Specialty DME billing company | Strong on DME MAC policy | Usually tracked | May require its platform | Percent or per claim |
| Software vendor RCM | Vendor workflows | Inside that platform only | Only that platform | Percent plus software |
| Luxen | Certified coders for DME MAC policies | Rental, oxygen and refill tracking | Yes, no migration | 3% to 6% of collections |
Use the same questions to compare medical billing companies.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
Enroll as a DMEPOS supplier, get a standard written order plus any required face-to-face note or prior authorization, and keep proof of delivery. Submit an 837P through CEDI to the DME MAC, with rental modifiers such as RR and KH, KI or KJ, and KX when policy criteria are met. File within 12 months of the date of service.
Luxen charges 3% to 6% of collections, month to month, with no setup or exit fee. For a DME supplier collecting $150,000 a month, that is $4,500 to $9,000. Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews).
About 2 weeks from a signed BAA to working claims; median time from signed BAA to first claims worked was 9 business days (Luxen client data). We start with your oldest rental months and denials, and first recovered payments arrived a median of 17 days after work began (Luxen client data). Nothing migrates, because we bill from your current DME platform.
The best system is usually the one your intake, delivery and resupply teams already run, as long as it sends clean 837P files through CEDI and tracks rental months, orders and proof of delivery. DME suppliers often run Brightree, Bonafide, NikoHealth, Fastrack or WellSky CareTend. Luxen bills inside any of them, so outsourcing does not mean switching software.
Yes, for fitting and training, if the item is delivered no earlier than 2 days before discharge and is for use at home. The date of service on the claim is the discharge date, and nothing is billed for the days before discharge. Supplies do not qualify, and equipment used during a covered Part A stay is part of the facility payment.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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