CMS Releases Oxygen Billing Info

Through its listserv, CMS has released the following guidance on
oxygen and oxygen equipment, including billing for contents and
replacement equipment as well as documentation guidelines.

The agency said an MLN Matters article will be forthcoming that
incorporates the information included in its message, which
follows:

Medicare Billing Requirements and
Policies for Replacement of Oxygen Equipment and Oxygen
Contents

This message is for suppliers and home health
agencies that furnish oxygen and oxygen equipment to Medicare
beneficiaries

Suppliers of oxygen and oxygen equipment need to be aware of the
procedures for submitting claims for oxygen and oxygen equipment
following the enactment of the Medicare Improvements for Patients
and Providers Act of 2008 (MIPPA) on July 15, 2008.

Section 144(b) of MIPPA took effect on January 1, 2009, and
repeals the requirement for you to transfer title to oxygen
equipment to the beneficiary after the 36 month payment cap
mandated by the Deficit Reduction Act of 2005. Section 144(b) of
MIPPA also establishes new payment rules and supplier
responsibilities following the 36 month payment period. See MLN
Matters number SE0840 for additional information about these new
rules. This listserv message provides specific instructions for
submitting claims for oxygen contents and replacement of oxygen
equipment.

REPLACEMENT OF OXYGEN EQUIPMENT

New HCPCS Modifier for Replacement of DME
Effective January 1, 2009, the following modifiers was added to the
Healthcare Common Procedure Coding System (HCPCS):

RA – Replacement of a DME item;

This modifier is to be used on claims for replacement of oxygen
equipment with dates of service on or after January 1, 2009. HCPCS
modifier RP, which was discontinued effective December 31 2008,
remains in effect for claims with dates of service prior to January
1, 2009.

• If oxygen equipment is replaced because the equipment has been
  in continuous use by the patient for the equipment’s
  reasonable useful lifetime or is lost, stolen, or irreparably
  damaged, the patient may elect to obtain a new piece of equipment.
  Irreparable damage refers to a specific incident of damage to
  equipment such as equipment falling down a flight of stairs as
  opposed to equipment that is worn out over time. In these
  situations, a new 36-month rental period and new reasonable useful
  lifetime is started on the date that the new, replacement item is
  furnished. Claims for the replacement of oxygen equipment for the
  first month of use only are billed using the HCPCS code for the new
  equipment and either the RA or RP HCPCS modifier depending on the
  date that the equipment is furnished.

• You must include on the claim for the first month of use a
  narrative explanation of the reason why the equipment was replaced
  and supporting documentation must be maintained in your files. For
  example, if equipment is stolen, you should keep a copy of the
  police report in your files. For lost or irreparably damaged
  equipment, you should maintain any documentation that supports the
  narrative account of the incident. For reasonable useful lifetime
  replacements, the narrative explanation should include the date
  that the beneficiary received the equipment being replaced.

• When submitting claims electronically for replacement of oxygen
  equipment, you may use, for the narrative explanation, loop 2400
  (line note), segment NTE02 (NTE01=ADD) of the ASC X12, version
  4010A1 professional electronic claim format. If you are billing
  using the Form CMS-1500 paper claim, you may report this
  information in item 19 of the claim form.

• If you are a home health agency submitting claims
  electronically for replacement of oxygen equipment, you may use,
  for the narrative explanation, loop 2300, segment NTE (billing
  note) of the ASC X12, version 4010A1 institutional electronic claim
  format. If you are a home health agency billing using the UB-04
  paper claim, you may report this information in Form Locator 80
  (Remarks).

• A new certificate of medical necessity (CMN) is required in
  situations where oxygen equipment is replaced because the equipment
  has been in continuous use by the patient for the equipment’s
  reasonable useful lifetime or is lost, stolen, or irreparably
  damaged. New testing, however, is not required unless it is
  necessary in order to meet existing medical review guidelines for
  oxygen and oxygen equipment. You should continue to follow the
  existing guidelines requiring recertification CMNs for all
  situations in which oxygen equipment is being replaced. The most
  recent qualifying value and testing date should be entered on the
  CMN.

• As is the case for all DME items, you must maintain
  proof-of-delivery documentation in your files for replacement
  oxygen equipment. In addition, for equipment that is being replaced
  because it has been in continuous use by the beneficiary for the
  reasonable useful lifetime and the beneficiary has elected to
  obtain new equipment, you must also have proof-of-delivery
  documentation in your files for the item being replaced that
  documents that the oxygen equipment has been in use for at least 5
  years.

Change in Oxygen Equipment during the Reasonable Useful
Lifetime Period

• The reasonable useful lifetime for stationary or portable
  oxygen equipment begins when the oxygen equipment is first
  delivered to the beneficiary and continues until the point at which
  the stationary or portable oxygen equipment has been used by the
  beneficiary on a continuous basis for 5 years. Computation of the
  reasonable useful lifetime is not based on the age of the
  equipment.

• If there is a change in oxygen equipment modalities (e.g., from
  a concentrator to a stationary liquid oxygen system) prior to the
  end of the reasonable useful lifetime period, this does not result
  in the start of a new reasonable useful lifetime period or a new 36
  month payment period. In addition, if you have to replace oxygen
  equipment that is not functioning properly prior to the end of the
  reasonable useful lifetime period, this does not result in the
  start of a new reasonable useful lifetime period or a new 36 month
  payment period. Finally, if the beneficiary switches to a new
  supplier and new equipment prior to the end of the reasonable
  useful lifetime period, this does not result in the start of a new
  reasonable useful lifetime period or a new 36 month payment
  period.

• A beneficiary may elect to obtain new oxygen equipment at the
  end of the 5 year reasonable useful lifetime period in these
  situations.

Clarification of Policy Regarding Continuous Use of Oxygen
and Oxygen Equipment

• The instructions pertaining to payments for capped rental items
  during a period of continuous use now apply to the monthly payment
  amounts for oxygen and oxygen equipment and the portable oxygen
  equipment add-on payments.

• A period of continuous use allows for temporary interruptions
  in the use of the equipment. For breaks in need (beneficiary no
  longer needs or uses the equipment) of less than 60 days plus the
  days remaining in the last paid rental month, the period of
  continuous use does not start over and so the count of continuous
  months picks up where it left off before the break. For example, if
  the last paid rental month is month #31 and there is a 50 day break
  in need, the next paid rental month would be month #32.

• If, however, there is a break in need more than 60 days plus
  the days remaining in the last paid rental month, and the need for
  the equipment resumes at a later date, a new period of continuous
  use, a new 36-month payment period, and a new reasonable useful
  lifetime period would begin provided that you have submitted the
  following:

AND

PLEASE NOTE: If medical necessity for the equipment
continues during a break in billing/Part B payment (e.g., the
beneficiary is hospitalized for 70 days but continues to use oxygen
equipment during the hospital stay), this DOES NOT constitute a
break in need, and therefore, a new period of continuous use
DOES NOT begin. In these situations, the count of continuous months
picks up where it left off before the break.

OXYGEN CONTENTS

Payment for Oxygen Contents (General Policy)

• If you furnished liquid or gaseous oxygen equipment during the
  36-month rental period, you are responsible for furnishing the
  oxygen contents used with the oxygen equipment for any period of
  medical need following the 36-month rental cap for the remainder of
  the reasonable useful lifetime of the equipment.

• In these situations, you can bill for and receive a monthly
  payment for furnishing oxygen contents (see chart below).

Payment for Oxygen Contents (When Monthly Payments May
Begin)

• Payment for both oxygen contents used with stationary oxygen
  equipment and oxygen contents used with portable oxygen equipment
  is included in the 36 monthly payments for oxygen and oxygen
  equipment (stationary oxygen equipment payment) made for codes
  E0424, E0439, E1390, or E1391. Beginning with dates of service on
  or after the end date of service for the month representing the
  36th payment for code E0424, E0439, E1390, or E1391, you may bill
  on a monthly basis for furnishing oxygen contents (stationary
  and/or portable), but only in accordance with the following
  chart:

• You may not bill for stationary oxygen contents if the
  beneficiary uses a stationary concentrator and you may not bill for
  portable oxygen contents if the beneficiary uses a portable
  concentrator or transfilling equipment.

PLEASE NOTE: The descriptors for HCPCS codes E0441
through E0444 reflect older policies and regulations and need to be
revised to reflect current policies and regulations. For now, each
of these four codes represents monthly delivery of either
stationary or portable oxygen contents. The language in parentheses
in the descriptors for each of these codes should be
disregarded.

• If the beneficiary began using portable gaseous or liquid
  oxygen equipment (E0431 or E0434) more than one month after they
  began using stationary oxygen equipment, monthly payments for
  portable gaseous or liquid oxygen contents (E0443 or E0444) may
  begin following the stationary oxygen equipment payment cap
  AND prior to the end of the portable equipment payment cap
  (code E0431 or E0434). As long as the beneficiary is using covered
  gaseous or liquid portable oxygen equipment, payments for portable
  oxygen contents may begin following the stationary oxygen equipment
  payment cap. This will result in a period during which monthly
  payments for E0431 and E0443, in the case of a beneficiary using
  portable gaseous oxygen equipment, or E0434 and E0444, in the case
  of a beneficiary using portable liquid oxygen equipment, overlap.
  In these situations, after the 36-month portable oxygen equipment
  payment cap for E0431 or E0434 is reached, monthly payments for
  portable oxygen contents (E0443 or E0444) would continue.

• If the beneficiary began using portable gaseous or liquid
  oxygen equipment (E0431 or E0434) following the 36-month stationary
  oxygen equipment payment period, payments may be made for both the
  portable equipment (E0431 or E0434) and portable contents (E0443 or
  E0444).

• In all cases, separate payment for oxygen contents (stationary
  or portable) would end in the event that a beneficiary receives new
  stationary oxygen equipment and a new 36-month stationary oxygen
  equipment payment period begins (i.e., in situations where
  stationary oxygen equipment is replaced because the equipment has
  been in continuous use by the patient for the equipment’s
  reasonable useful lifetime or is lost, stolen, or irreparably
  damaged). Again, the monthly payment for stationary oxygen
  equipment includes payment for both stationary and
  portable oxygen contents. Therefore, under no circumstances can you
  receive both the monthly stationary oxygen equipment payment and
  payment for either stationary or portable oxygen
  contents.

Proof-of-Delivery Requirements for Oxygen Contents

• Following the stationary oxygen equipment payment cap, you may
  bill for oxygen contents (stationary and/or portable in accordance
  with the chart above) on the anniversary date of the oxygen
  equipment billing.

For example, if the 36th month of continuous use of the
stationary oxygen equipment begins on March 11th and ends on April
10th, you may begin billing for monthly oxygen contents that the
beneficiary will use after the cap on April 11th.

• For subsequent months, you do not need to deliver the oxygen
  contents every month in order to continue billing for the contents
  on a monthly basis. A maximum of 3 months of oxygen contents can be
  delivered at one time. In these situations, the delivery date of
  the oxygen contents does not have to be the DOS (anniversary date)
  on the claim. However, in order to bill for contents for a specific
  month, you must have previously delivered quantities of oxygen that
  are sufficient to last for one month following the date of service
  on the claim. You are required to have proof-of-delivery for each
  actual delivery of oxygen, but as discussed above, this may be less
  often than monthly.

For example, if you deliver 30 oxygen tanks on April 11th and
the beneficiary only uses 15 tanks from April 11th through May 10th
and 15 tanks from May 11th through June 10th, you may bill for
contents on April 11th and again on May 11th for contents delivered
on April 11th that were used for two months.

A Change Request (CR) and a MLN Matters Article will be
forthcoming that will incorporate the information contained in this
listserv message.