February 4, 2009 - Updated 02.05.09
Oxygen FAQs
Revised Oxygen Frequently Asked Questions 02/04/2009
Q. If a patient moves outside of the supplier’s service area before the 36th continuous rental payment has been made, can the beneficiary obtain equipment from the new supplier?
A. Yes. However, the new supplier will only receive payment for the remaining months of the 36 month rental period. A new rental period is not allowed in this situation.
Q. Does the reasonable useful lifetime of equipment restart if it is swapped out or is it still based on the initial date of service?
A. The useful lifetime of oxygen equipment does not restart due to changes in modality; the expected useful lifetime is based on the initial date.
Q. May suppliers provide a new piece of equipment to patients who began using their current oxygen equipment prior to 01/01/03 , and start a new capped rental period?
A. Yes, but only once the useful lifetime (60 months/5 years) has expired can a new capped rental period begin (36 months). Suppliers may not arbitrarily issue new equipment.
Q. Will suppliers be able to bill for high or low liter flows after the 36 month rental period, or will the payment be fixed?
A. The oxygen contents fee is a monthly fee for providing the patients monthly oxygen contents needs, payment cannot be adjusted based on LPM of oxygen used.
Q. If a patient refuses to pay their coinsurance or deductibles, are suppliers obligated to continue doing business with that patient?
A. MIPPA does not provide an exception in a case where a patient has outstanding coinsurance or deductibles. Suppliers must continue to furnish the oxygen. Suppliers may follow their normal processes to collect outstanding balances.
Q. What happens when there is an interruption in medical necessity for the oxygen equipment during the 36-month rental payment period (before the 36th continuous rental payment has been made)?
A. If there is an interruption in medical necessity of less than 60 days plus the days remaining in the last paid rental month (e.g., month 20), once the need resumes, the supplier would submit a claim for the next rental month and the count of continuous rental months would pick up at where the rental payments suspended (e.g., month 21).
If there is an interruption in medical necessity of greater than 60 days plus the days remaining in the last paid rental month, once the need resumes, the supplier would collect supporting documentation (made available upon request) of the new medical need including but not limited to:
- New prescription (detailed written order)
- New CMN (with new qualifying oxygen test results performed within 30 days of new initial date)
- Documentation supporting new medical need
- Documentation explaining interruption of need
- Documentation supporting length of interruption (e.g., pick up date, redelivery date)
The claim for the first month of the new rentals meeting the above documentation should include:
- New CMN
- Narrative statement, “Break in medical need greater than 60 days.”
- RA modifier on each HCPCS code
( Note: do not include any of the above on subsequent claims )
Q. What happens when the patient is admitted to a hospital or SNF for a period that is greater than 60 days plus the days remaining in the last paid rental month (e.g., month 20)?
A. Unless the supplier submits the appropriate documentation to show that there was also a break in medical need of greater than 60 days plus the remaining days in the final month’s rental for the oxygen equipment during this time, medical necessity is presumed to have continued during this time and the count of continuous rental months would pick up where the previous rental payments suspended (e.g., at month 21) once the supplier submits the claim for the next rental month.
Q. If a patient uses liquid or gaseous stationary oxygen equipment after the 36 month cap for the equipment and also uses liquid or gaseous portable oxygen equipment after the 36 month cap for the equipment, how many monthly contents fees may the supplier bill to the DME MAC when furnishing both the stationary and portable oxygen contents?
A. The supplier may bill for both the stationary oxygen contents and the portable oxygen contents furnished for each month.
Q. Can a supplier require the patient to pick up their oxygen equipment or contents?
A. No. The Supplier Standards do not allow a supplier to require the beneficiary to pick up oxygen equipment. The beneficiary may, however, choose to pick up the equipment.
Q. After the 36 month capped period, can a supplier deliver a 3 month supply of contents to a patient at one time?
A. Yes. However, the supplier may only bill the DME MAC for the contents on a monthly basis.
Q. In the situation described above, is proof of delivery documentation required for each month?
A. No. Proof of delivery documentation for the one delivery is all that is required for all 3 months.
Q. Is the 6 months maintenance and service (MS) following the 36 month period a definitive 6 months?
A. Yes, the supplier must check on the equipment at least every 6 months to insure it is in working order. If the equipment requires servicing more frequently the supplier is required to service the items as often as necessary, Medicare, however, will not pay for a visit that takes place any sooner than 6 months after the last day of the 36th continuous paid rental month. The decision for maintenance and service payments beyond 2009 is still pending so only one MS payment is allowed in 2009.
Q. If a patient uses their oxygen supply outside the home is there a limit to the amount of contents the supplier may provide?
A. Medicare considers coverage for portable oxygen if its primary use is to ambulate within the home. There are no limitations on patients leaving their homes. Therefore, contents cannot be withheld.
Q. If after the 36 month period, a patient moves to a state that the supplier is not licensed, how does the supplier continue providing service?
A. In this case it is a statutory requirement that the supplier continue to provide service without charging Medicare or the beneficiary (except contents and MS where appropriate). However, the service may be contracted out to a supplier local to the beneficiary.
A Change Request (CR) and a MLN Matters Article will be forthcoming that will incorporate specific instructions for proper oxygen replacement/contents claims submission. For an overview of the instructions please review the CIGNA Government Services ListServ article titled, "Medicare Billing Requirements and Policies for Replacement of Oxygen Equipment and Oxygen Contents," dated January 27, 2009.
