Clinicians: Are You Ordering Oxygen for Your Patient?

When ordering oxygen therapy for patients who are Medicare beneficiaries, you must see him/her within 30 days prior to the start of oxygen therapy to discuss the condition necessitating the home use of oxygen and he/she must meet coverage indications and a qualifying test as outlined in the DMEMAC Oxygen and Oxygen Equipment Local Coverage Determination (LCD).

Medical record documentation must also show that other alternative treatments (e.g., medical and physical therapy directed at secretions, bronchospasm and infection) have been tried or considered and deemed clinically ineffective. The medical record and prescription should indicate the oxygen flow rate (e.g., 2 liters per minute), the estimation of the frequency (e.g., 30 minutes per hour), duration of use (e.g., 12 hours per day) and duration of need (e.g., 12 months).

The type of oxygen delivery system to be used must be specified (e.g., a portable as well as a stationary concentrator or a compressed gas portable system along with a stationary concentrator). If a portable system is ordered, there are specific requirements that must be included in the medical record, including that the patient is mobile within the home and that the qualifying blood gas study was performed either at rest or while exercising, but not while asleep.

In addition, for scenarios where the beneficiary has different daytime and nighttime oxygen flow requirements, these values must be documented in the patient's medical record. This information is used by the DME supplier to determine billing information for Medicare.

Medicare can make payment for home oxygen supplies and equipment when the patient's medical record shows that the he/she has significant hypoxemia from a medical condition and meets medical documentation, test results, and health conditions as specified in the CMS Internet Only Manual (IOM), Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Section 240.2.

Complete and sign Form CMS-484 (Certificate of Medical Necessity (CMN): Oxygen) in a timely manner; however, the CMN itself is not considered part of the medical record. All information included on the CMN must be supported by the contemporaneous medical record. See form completion instructions in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 5.

The Comprehensive Error Rate Testing (CERT) contractor has identified multiple errors in claims received for oxygen equipment and supplies. These errors include no documentation of an encounter prior to the oxygen order, no documentation of oxygen orders prior to delivery, no indication of the qualifying test results in the medical record as reported on the CMN, and no documentation to support continued need for home oxygen therapy.

To help patients, the DME suppliers, and the Medicare program, be sure to verify that the medical documentation supports the oxygen orders and CMNs as this allows Medicare to pay claims appropriately and efficiently.

For additional information and resources on Medicare's coverage of oxygen and oxygen equipment, visit the DME MAC contractor websites.


Last Updated Feb 05, 2020