[Brian Hagan]

LCD states that on a patient owned Hospital Bed that after a year the patient is eligible for a new mattress.

I have billed this one other time under this same time frame and it was turned down.

From what I show is that it needs to be billed with a NU KX RA modifier and patient owned date and reason in the NTE section...

Can anyone confirm this or give me their insight on how they have billed it to get re-imbursed?

Thanks in advance..

[Regina]

What denial are you getting?

[Brian Hagan]

The last time I billed for a replacement mattress was over three years ago due to the denial at that time. Since there wasn't an ABN we were unable to bill the patient for the denial. After that point in time we haven't done another replacement mattress. I don't have the patient and or the EOB accessible on that denial at this time but was inquiring since I have had and increase in the amount of patients requesting a replacement mattress.

I am just wanting to find out what people are doing that has been successful in getting re-imbursed for the mattress. Any help would be appreciated.

[Regina]

Brian- what is the exact denial you are getting? It's hard to tell what's wrong without knowing that.