Oxygen - JA DME
Oxygen
Coverage
- Home Use of Oxygen (240.2) National Coverage Determination (NCD)
- Oxygen and Oxygen Equipment Local Coverage Determination (LCD)
- Oxygen and Oxygen Equipment Policy Article
Documentation
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Checklist High Liter Flow Oxygen - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Letter - Continued Medical Necessity - Clinician directed letter that reminds them that ongoing need for and use of a DMEPOS item must be documented in the patient's medical record
- Clinician Letter - Home Oxygen Initial Qualification Testing - Clinician directed letter that reviews blood oxygen testing requirements
- Oxygen and Oxygen Equipment Documentation Checklist - Checklist to ensure suppliers gather all required documentation
Oxygen Q Modifiers
Reminder: Both the portable and stationary should have the same Q Modifiers appended to the claim lines.
| Codes | Modifiers | Liters Per Minute (LPM) | Fee Schedule |
|---|---|---|---|
| Stationary: (e0424, e0425, e0439, e0440, e1353, e1390, e1391, e1405, e1406) |
QE - Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute QA - Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute (LPM) |
Less than 1 and is ONLY for stationary | .5 of the fee schedule amount. |
| Stationary: (e0424, e0425, e0439, e0440, e1353, e1390, e1391, e1405, e1406) |
QG - Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (LPM) QR - Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute (LPM) |
Greater than 4 and patient is ONLY receiving stationary | 1.5 times fee schedule |
| Stationary: (e0424, e0425, e0439, e0440, e1353, e1390, e1391, e1405, e1406) Portable: (E0430, E0431, E0433, E0434, E0435, E1392, K0738) |
QF - Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (LPM) and portable oxygen is prescribed QB - Prescribed amounts of stationary oxygen for daytime used while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (LPM) and portable oxygen is prescribed |
Greater than 4 and the beneficiary is receiving both stationary and portable | Stationary: Fee Schedule Portable: .5 of the fee for the stationary or the portable amount whichever is greater |
Oxygen N Modifiers
The Centers for Medicare and Medicaid Services (CMS) announced the new N-modifiers for oxygen. The 3 new modifiers for home oxygen use under national coverage determination (NCD) 240.2 and the DME MAC Oxygen and Oxygen Equipment Local Coverage Determination (LCD) and LCD-related Policy Article (PA) were created to indicate the appropriate treatment regimen and presence of supporting documentation for each Medicare patient oxygen therapy group:
LCD Group I: modifier N1 (NCD Section B)
LCD Group II: modifier N2 (NCD Section B)
LCD Group III: modifier N3 (NCD Section D)
The new modifiers are effective January 1, 2023 and are required for initial setups with dates of service on or after April 01, 2023.
| Codes | Modifiers | Description |
|---|---|---|
| Stationary: (e0424, e0425, e0439, e0440, e1353, e1390, e1391, e1405, e1406) Portable: (E0430, E0431, E0433, E0434, E0435, E1392, K0738) |
N1 | Group 1 Coverage Criteria: Effective dates of service 01/01/2023 and after. Required for initial Dates of Service 4/01/2023 and after. |
| Stationary: (e0424, e0425, e0439, e0440, e1353, e1390, e1391, e1405, e1406) Portable: (E0430, E0431, E0433, E0434, E0435, E1392, K0738) |
N2 | Group II Coverage Criteria: Effective dates of service 01/01/2023 and after. Required for initial Dates of Service 4/01/2023 and after. |
| Stationary: (e0424, e0425, e0439, e0440, e1353, e1390, e1391, e1405, e1406) Portable: (E0430, E0431, E0433, E0434, E0435, E1392, K0738) |
N3 | Group III Coverage Criteria: Effective dates of service 01/01/2023 and after. Required for initial Dates of Service 4/01/2023 and after. |
Tips
FAQ - Oxygen
View collaborative Noridian and CGS FAQ for oxygen policy changes January 1, 2023
Oxygen and Oxygen Equipment Payment Categories
The Oxygen and Oxygen Equipment Payment Category includes a 36-month limit on monthly payments for stationary and portable oxygen equipment. Replacement of oxygen, change in oxygen equipment during reasonable useful lifetime period, billing contents, and modifiers.
Reviews/Audits
- Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
