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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

Topic Detail
FAQ - Oxygen View collaborative Noridian and CGS FAQ for oxygen policy changes January 1, 2023
Oxygen and Oxygen Equipment Payment Categories Oxygen and oxygen equipment - Includes 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

Resources

Last Updated Feb 19 , 2024

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