Article Detail - JD DME
RETIRED - Coverage Reminder - High Liter-Flow Oxygen (4 LPM)
Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.
Posted July 12, 2013
Recent reviews of high liter-flow oxygen claims have identified errors in billing for high liter-flow and portable oxygen systems. This article will review basic coverage and documentation requirements.
Oxygen and oxygen equipment is eligible for payment for beneficiaries who have a qualifying medical condition that results in hypoxemia (low blood oxygen levels). A stationary oxygen system is the equipment covered when a beneficiary qualifies. Additional payment is available for a portable system if it is necessary to move about inside the beneficiary's home.
There are three payment levels for oxygen based upon the liter-flow prescribed:
- Less than 1 lpm - pays less than the standard payment amount
- 1-4 lpm - is the standard payment amount
- Greater than 4 lpm - pays more than the standard payment amount
In order to qualify for the highest payment level, greater than 4 lpm, a second blood oxygen test must be obtained while the beneficiary is breathing oxygen at 4 lpm. A qualifying test result must be obtained while at that liter-flow in order to justify payment at the higher rate. If the beneficiary qualifies for payment at the higher rate, there is no additional payment for a portable oxygen system. The INDICATIONS AND LIMITATIONS OF COVERAGE AND/OR MEDICAL NECESSITY section of the LCD states:
LITER FLOW GREATER THAN 4 LPM:
If basic oxygen coverage criteria have been met, a higher allowance for a stationary system for a flow rate of greater than 4 liters per minute (LPM) will be paid only if a blood gas study performed while the beneficiary is on 4 or more LPM meets Group I or II criteria. If a flow rate greater than 4 LPM is billed and the coverage criterion for the higher allowance is not met, payment will be limited to the standard fee schedule allowance. (Refer to related Policy Article for additional information on payment for greater than 4 LPM oxygen.) (emphasis added)
The NONMEDICAL NECESSITY COVERAGE AND PAYMENT RULES section of the related Policy Article states:
Payment for stationary equipment is increased for beneficiaries requiring greater than 4 liters per minute (LPM) of oxygen flow and decreased for beneficiaries requiring less than 1 LPM. If a beneficiary qualifies for additional payment for greater than 4 LPM of oxygen and also meets the requirements for portable oxygen, payment will be made for the stationary system at the higher allowance, but not for the portable system. In this situation, if both a stationary system and a portable system are billed for the same rental month, the portable oxygen system will be denied as not separately payable. (emphasis added)
Modifiers QF and QG must be used when submitting the claim.
- QF - Prescribed amount of oxygen is greater than 4 liter per minute (LPM) and portable oxygen is prescribed
- QG - Prescribed amount of oxygen is greater than 4 liters per minute (LPM)
Refer to the Oxygen and Oxygen Equipment LCD, related Policy Article and Supplier manual for additional information about coverage and documentation requirements.
Last Updated Thu, 10 Jan 2019 12:33:42 +0000