Replacement and Repair
The RP modifier indicates replacement and repair.
Equipment the beneficiary owns may be replaced in cases of loss or irreparable damage without a physician's order. Claims involving replacement equipment necessitated because of wear or a change in the patient's condition must be supported by a current physician's order.
Repairs to equipment the beneficiary owns are covered when necessary to make the item serviceable. If the expense for repair exceeds the estimated expense of purchasing or renting another item for the remaining period of medical need, no payment can be made for the amount of the excess. Repairs of rented equipment are not covered.
Prosthetics and Orthotics
Many of the HCPCS codes in this category require the use of a K modifier. Reference the Lower Limb Prostheses policy for a listing of codes.
• K0 Lower limb extremity prosthesis functional Level 0 - Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility
• K1 Lower extremity prosthesis functional Level 1 - Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulatory
• K2 Lower extremity prosthesis functional Level 2 - Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulator
• K3 Lower extremity prosthesis functional Level 3 - Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion
• K4 Lower extremity prosthesis functional Level 4 - Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete