Article Detail - JD DME

Original Effective Date: 05/07/2009           
Revision Effective Date: 11/01/2013

A new payment policy for oxygen became effective on January 1, 2009. This article addresses issues related to short term travel (e.g., days or weeks) or to temporary relocation (e.g., snowbird) outside of the supplier's service area.

In this article, the term "oxygen" includes the equipment, contents (if applicable), and all related items and services including, but not limited to accessories, maintenance, and repairs.

In this article, the following terms are used:

• Home supplier refers to the supplier of the oxygen prior to travel or relocation.
• Temporary supplier (non-billing) refers to another supplier with whom the home supplier has made arrangements for provision of oxygen but who will not be billing Medicare for the oxygen. The home supplier will bill for the oxygen.
• Temporary supplier (billing) refers to a supplier in the travel/temporary location who will be billing Medicare for the oxygen instead of the home supplier.

36 month rental period

In all cases, an oxygen supplier must provide or arrange for oxygen to be provided to the beneficiary for the entirety of each month for which it receives payment.

• Medicare will pay only one supplier to provide oxygen during any one rental month.
• Requirements for the home supplier:
  • If the beneficiary travels or relocates outside the supplier's service area, then for the remainder of the rental month for which it billed, the home supplier is required to provide the oxygen itself or arrange for a temporary supplier (non-billing) to provide the oxygen.
  • For subsequent rental months that the beneficiary is outside the service area, the home supplier is encouraged to either provide or arrange for the oxygen itself or assist the beneficiary in finding a temporary supplier (billing) in the new location.
  • If the home supplier provides oxygen to the patient for use out-of-area or arranges for a temporary supplier (non-billing) to provide the oxygen, the home supplier bills for whatever system the patient is using on the anniversary date/billing date. The supplier may provide the patient with different oxygen equipment (e.g., portable concentrator) for travel, if there is an order from the physician.
  • The home supplier may not bill for or be reimbursed by Medicare if it is not providing oxygen or has not arranged for a temporary supplier (non-billing) to provide the oxygen on the anniversary billing date.
• If a temporary supplier (billing) provides equipment:
  • If it is during a month in which the home supplier has not billed Medicare, claims from the temporary supplier (billing) would be paid, if all coverage criteria and payment rules are met.
  • If it is during a month in which the home supplier has billed Medicare and it is not provided under an arrangement with the home supplier, then the claim from the temporary supplier (billing) will be denied as not medically necessary, if it bills Medicare.
  • If the beneficiary returns home before the end of a rental month for which the temporary supplier (billing) has billed, it must provide oxygen itself for the entirety of that month or make arrangements with the home supplier to provide the oxygen.
  • The temporary supplier (billing) must provide a copy of a valid CMN, an order (if the order information was not included on the CMN), a report of the qualifying blood gas study, and documentation of any required physician visit, if requested.

Months 37-60

• The supplier providing oxygen to the patient during the 36th month is required to provide oxygen to the patient either directly or under arrangements with a temporary supplier (non-billing) for beneficiary use out-of-area.
• The home supplier could provide the patient with different oxygen equipment (e.g., portable concentrator) for travel, if there is an order from the physician.
  • The supplier would not submit a claim for that equipment (because it is required to continue to provide equipment after the 36 month cap).
• If the beneficiary had a gaseous or liquid system during the 36th month and the supplier was providing contents to the patient during months 37-60, it may only bill and will only be reimbursed for contents if the patient was using contents at some time during the billed month. It may not bill for contents if, for example, the beneficiary was using a portable concentrator during the entire month.

Miscellaneous

• Oxygen services furnished by an airline are noncovered. Payment for oxygen furnished by an airline is the responsibility of the beneficiary and not the responsibility of the supplier.

This article only addresses travel and relocation in the United States and its territories. Medicare does not cover items or services provided outside the United States and the supplier is not required to provide or arrange for oxygen outside the United States.