ClaimCarePro

DME Billing Services

ClaimCarePro provides DME billing services for durable medical equipment, prosthetics, orthotics and supplies: HCPCS coding, RR/NU/UE and capped-rental modifiers, KX documentation, prior authorization, proof of delivery and resupply, and DMEPOS supplier enrollment, billed to the DME MAC and to commercial and Medicaid plans. Full-service billing is 6% of collections with a $1,000/month minimum, month-to-month, no setup fee. Family-owned in Clearwater, Florida, billing since 2010.

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What our DME billing services include

HCPCS coding for DMEPOS

Equipment, prosthetics, orthotics and supplies coded in HCPCS Level II to the exact item delivered, checked against the PDAC product classification when the code depends on the device, and billed to the DME MAC — Jurisdiction C (CGS) for Florida patients — or to the commercial plan's DME vendor.

Rental, purchase and capped-rental modifiers

NU for new purchased equipment, UE for used, RR for rentals, and the capped-rental month modifiers KH, KI and KJ counted correctly through the 13th month, after which title passes to the patient. A rental month billed with the wrong modifier, or a 14th month billed at all, is the classic DME denial.

KX and the coverage criteria behind it

KX tells Medicare the item's local coverage determination requirements are met. We add it only when the record supports it — the qualifying test, the face-to-face visit, the order — and use GA or GZ when they are not, so the claim is honest and the advance notice is in place.

Orders, documentation and prior authorization

Standard written orders checked for every required element before delivery, face-to-face encounters and written orders prior to delivery obtained for the items that need them, and prior authorization requests filed for items on Medicare's Required Prior Authorization List and for commercial plans that require it.

Proof of delivery and resupply

Signed delivery tickets matched to the claim date of service, shipping records kept for mail-order items, and recurring supplies billed only after the patient confirms the need inside the refill window, so a post-payment review finds what it asks for.

Denial management for DME claims

Same-or-similar denials, missing-order denials, rental-month errors, frequency limits, and claims denied because the patient was in a skilled nursing facility or hospice on the delivery date — each traced to its cause, corrected or appealed with the record, and fixed upstream.

Competitive bidding and fee schedules

Items billed at the DMEPOS fee schedule or the single payment amount that applies, and the next round of competitive bidding — national remote-item-delivery programs for supplies such as CGMs, ostomy and urological supplies and off-the-shelf braces, starting no earlier than 2028 — tracked against what you dispense.

Supplier enrollment and payer contracts

Medicare DMEPOS supplier enrollment on the CMS-855S, Florida Medicaid and managed care enrollment, and commercial DME networks, by the team that bills the claims. A flat $250 per payer application.

Why DME claims deny — and how we prevent it

A rental month billed with the wrong modifier

Capped rental items are paid month by month for up to 13 months of continuous use. KH, KI and KJ mark where the patient is in that count; a break in service, a change of supplier or a miscounted month makes the claim deny or pay at the wrong rate.

The paperwork moved off the CMN and into the record

Certificates of medical necessity were eliminated for dates of service from January 1, 2023, and a claim sent with one is returned. The coverage criteria did not go away: they now have to be in the order and the medical record, which is exactly what an audit reads.

Same-or-similar equipment already on file

Medicare will not pay for a second item that serves the same purpose as one the patient already has inside its useful lifetime. Checking same-or-similar before delivery is the only way to avoid giving away the equipment.

KX on a claim the record does not support

KX is an attestation that the LCD criteria are met. A KX on a claim without the qualifying test, face-to-face note or order is an overpayment waiting to be found. The fix is to check the criteria before the item ships.

Prior authorization and written orders before delivery

Items on Medicare's Required Prior Authorization List, such as power mobility devices and certain orthoses, deny without an affirmed request on file. Commercial and Medicaid plans keep their own lists, and they change.

Inpatient, SNF and hospice dates

Equipment delivered while the patient is a hospital inpatient, in a covered skilled nursing facility stay or under hospice for a related condition is generally not billable to the DME MAC. Eligibility has to be checked against those dates, not just against active coverage.

Supplier standards and Florida licensing

A Medicare DMEPOS supplier must meet the federal supplier standards, keep accreditation and a surety bond, and in Florida hold an AHCA home medical equipment licence where the law requires one. A lapse in any of them stops payment on every claim.

Resupply billed too early

Recurring supplies such as CPAP accessories, diabetic supplies and ostomy supplies have refill rules: the patient confirms the need close to when the current supply runs out. Auto-shipping on a calendar is one of the first things a reviewer looks for.

DME billing services cost: in-house vs outsourced

What outsourced DME billing costs here

Full-service DME billing is 6% of collections with a $1,000 monthly minimum, month-to-month, no setup fee. Aged or denied claims are worked on a 10% contingency, paid only from what is recovered. The price is on our pricing page, not quoted after a sales call.

What in-house DME billing costs

An in-house biller is a salary, benefits, training, billing software and clearinghouse fees, and the risk that one person is the only one who understands rental-month counting. A percentage fee moves with deposits; a payroll line does not.

Where in-house DME billing usually loses money

Not on the clean purchase claim. It loses money on rental months billed wrong, items delivered before the order was complete, same-or-similar items given away and resupply claims that cannot survive a review.

Do they know the DME MAC, not just Medicare Part B?

DME claims go to a different contractor under different rules from physician claims. Ask any DME billing company how it counts capped rental months, when it uses KX versus GA, and how it checks same-or-similar before delivery.

Will they sign a BAA, and can you leave?

Any company handling your patients' claims should sign a Business Associate Agreement before it sees a record. ClaimCarePro signs a BAA and bills month-to-month with no setup fee and no exit fee.

Who is behind the work?

ClaimCarePro is a family-owned billing company in Clearwater, Florida, billing since 2010, with 30+ years combined billing experience, a bench of experienced part-time billers scaled onto accounts as needed, and AI automation that checks each claim before it goes out.

How we take over your DME billing

  1. 1

    Free claims and A/R review

    We review 90 days of claims, remittances and aging for rental-month errors, missing orders, same-or-similar denials, KX use and unbilled resupply, then show you what is recoverable.

  2. 2

    Recover the aged and denied claims

    Denied rental months corrected, missing documentation obtained and claims reopened or appealed inside the limits, on a 10% contingency while new claims start.

  3. 3

    Map your product lines and payers

    Each product line mapped to its HCPCS codes, modifiers, LCD and order requirements; each payer's prior authorization list and fee schedule loaded; supplier enrollment and accreditation dates confirmed.

  4. 4

    Pre-delivery checks, then billing

    Order elements, face-to-face notes, prior authorization and same-or-similar checked before delivery; claims sent when the signed delivery ticket is in.

  5. 5

    Rental tracking, posting and follow-up

    Rental months tracked per patient, ERAs posted, denials worked by cause, secondary claims sent to Medicaid and supplemental plans, and a monthly report by product line and payer.

  6. 6

    Enrollment kept current

    Supplier revalidation, accreditation renewals, location changes and payer re-credentialing tracked before a lapse stops payment.

DME billing services: questions buyers ask

How much do DME billing services cost?
Most DME billing companies charge a percentage of collections. ClaimCarePro charges 6% of collections with a $1,000 monthly minimum, month-to-month, with no setup fee. Aged or denied claims are worked on a 10% contingency, paid only from what is recovered. Payer enrollment is a flat $250 per payer application.
Should a DME supplier outsource billing or keep it in-house?
Compare what each really costs. In-house billing is a fixed salary, benefits and software paid whether claims pay or not, and it depends on one person knowing rental-month counting and LCD criteria. An outsourced fee moves with collections. The deciding number is usually what your current denials and unbilled rentals are worth.
What do the RR, NU and UE modifiers mean?
RR marks a rental, NU a new item purchased and UE a used item purchased. Capped rental items also carry KH for the first month, KI for months two and three and KJ for months four through thirteen. Using the wrong one is a common reason a DME claim denies or pays the wrong amount.
Are certificates of medical necessity still required?
No. Medicare eliminated certificates of medical necessity and DME information forms for dates of service on or after January 1, 2023, and a claim sent with one is returned. The coverage criteria still apply: they must be documented in the order and the medical record, where a reviewer will look for them.
When should a DME claim use the KX modifier?
Only when every coverage requirement in the item's local coverage determination is met and documented. KX is an attestation, not a way to get paid. When the requirements are not met, GA (with a signed advance notice) or GZ is used instead. A KX the record does not support is an overpayment.
Which Medicare contractor processes DME claims in Florida?
DME claims for Florida patients go to the DME Medicare Administrative Contractor for Jurisdiction C, which is CGS. That is a different contractor, with different rules and portals, from the Part B contractor that pays physician claims. DMEPOS supplier enrollment, on the CMS-855S, is a separate Medicare enrollment as well.
How does competitive bidding affect DME billing?
In a competitive bidding area, Medicare pays the single payment amount for included items, and only contract suppliers may furnish them. Under CMS's 2025 final rule the next round becomes national remote-item-delivery programs for items such as CGMs, ostomy and urological supplies and off-the-shelf braces, starting no earlier than 2028.
Does a DME company in Florida need a state license?
Florida licenses home medical equipment providers through AHCA under chapter 400, part VII of the Florida Statutes, separately from Medicare enrollment. Medicare suppliers also have to meet the federal supplier standards, keep accreditation and hold a surety bond. A lapse in any of them can stop payment.
Why do DME claims get denied?
The common causes are an incomplete order, missing face-to-face documentation, no prior authorization, same-or-similar equipment already on file, a wrong rental-month modifier, delivery during an inpatient, SNF or hospice stay, and resupply sent too early. Each one can be checked before the item is delivered.
How do you switch DME billing companies without losing claims?
Give notice under your current contract, keep access to the billing system through the run-out, and pull an aging report plus the rental-month history for every active rental. A typical switch takes two to four weeks, with new claims flowing after mapping and old claims worked in parallel.

See what your DME claims are leaving unpaid

Last updated October 29, 2026. Reviewed by Jacob Greenberg, founder, ClaimCarePro. Send us 90 days of claims and remittances and we will show you the rental months billed wrong, the denials for missing orders and the resupply claims that can still be corrected. Billing is 6% of collections, month-to-month, no setup fee.

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Published pricing for Medicare, Florida Medicaid, managed care and commercial network enrollment.

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Orthopedic billing services

Braces and orthoses dispensed in the office, global surgery and fracture care.

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Podiatry billing services

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Prior authorization delays

Keeping authorization rules from stalling claims.

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