← Back to list
PAP222 - Durable Medical Equipment/Prosthetics/Orthotics/Supplies (DMEPOS)Modifiers - Added clarifying language
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 19, 2026
Summary
Blue Cross of Idaho clarified DMEPOS modifier requirements for rental (RR), lease (LL), and purchase (NU) items. Key updates include: breast pumps now default to purchase pricing regardless of modifier, oxygen accessories (E1353, E1355) are purchase-only items with a $1,000 prior authorization threshold, and specific modifiers (QE, QF, QG, AU, AW) have defined usage rules for oxygen equipment, urological/ostomy/tracheostomy supplies, and compression stockings. Claims without correct modifiers may be rejected or default to rental pricing.
Get alerts when payers change rules like this one
We check Blue Cross of Idaho and other payers every day and email you when a change matches your specialty and state.
Get Blue Cross of Idaho alertsPolicy Monitoring is free. No card required.
What to do
immediately · 9 steps
01Billing team must audit and update DMEPOS billing workflows for Blue Cross of Idaho commercial claims:
1. Update billing system rules to REQUIRE correct modifiers (RR, LL, NU) on all DMEPOS codes or claims will default to rental pricing or be rejected.
022. For breast pump claims: Verify modifier NU or RR is appended and confirm billing reflects PURCHASE pricing, not rental.
033. For oxygen equipment (E0424, E0439, E1390, E1391): When billing modifiers QE, QF, or QG for decreased/increased oxygen flow, ensure a corresponding claim for portable equipment (E1353 or E1355) is submitted on the same date of service on the same claim OR separately.
04Deny notices will result if portable equipment claim is missing.
054. For oxygen accessories (E1353, E1355): Bill with NU modifier only, verify total purchase price, and understand that prior authorization is waived if under $1,000 but post-claim review may occur for medical necessity.
065. For urological, ostomy, or tracheostomy supplies: Append modifier AU.
076. For compression stockings with surgical dressing: Append modifier AW.
087. Update provider education materials and billing instructions to reflect these modifier requirements.
09Consequence: Non-compliant claims will be electronically rejected, returned, or improperly priced.
Codes mentioned
E0424E0439E1390E1391E1353E1355
Original notice
PAP222 - Durable Medical Equipment/Prosthetics/Orthotics/Supplies (DMEPOS)Modifiers - Added clarifying language
providers.bcidaho.com · Always check the source before changing claims.