When billing for an upgraded item, Medicare requires the first line item on the claim to be the upgraded item and the second item to be the item that was prescribed.
Example: The customer has a Physician Order and only qualifies for a standard wheelchair (K0001) which rents for $50/mn and they decide that they would prefer to have a lightweight wheelchair (K0003) which rents for $75/mn. The customer will need to sign an ABN stating that they understand that they do not qualify for the upgraded item and will be responsible for the difference in cost – in this example the difference is $25/mn. This is how the HCPCS, modifiers and pricing will look on the claim:
K0003RRKHKXGA $25.00
K0001RRKHKXGK $50.00
The other example of billing for an upgrade is if the customer has a Physician Order for the same standard wheelchair (K0001) but the supplier opts to upgrade the customer at no additional fee to a lightweight chair (K0003)-maybe the supplier did not have a standard chair available at that time. Medicare still needs to know that they have been upgraded – no ABN required, however. This is how the item will bill:
K0001RRKHKXGL $50.00
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