CMS Issues Oxygen Payment Instruction

In a March 20 transmittal, CMS published additional
post-cap instruction about billing for the six-month maintenance
and service payments for oxygen equipment. The agency said it is
“reasonable and necessary to make payments for periodic, in-home
visits” to inspect certain oxygen equipment for calendar year 2009.
According to the transmittal, payment can only be made every six
months beginning six months after the cap period ends, as early as
July 1 for some patients. The allowed payment for each visit is
equal to the 2009 fee for code K0739, multiplied by 2, for the
state in which the in-home visit takes place. There is no decision
yet on coverage for maintenance and service beyond Dec. 31,
2009.

CMS said providers should use the HCPCS code for the equipment
E1390, E1391, E1392, and/or K0738 along with the MS modifier in
order to bill and receive payment for these visits.

For all oxygen equipment furnished after the 36-month rental
cap, providers are responsible for repairs or maintenance and
service “necessary to ensure that the equipment is in good working
order” for the remainder of its five-year reasonable useful
lifetime. Providers may not charge beneficiaries for any repairs,
parts or servicing required for the remainder of the equipment’s
reasonable useful lifetime, the transmittal said.

Further instructions will be published regarding payments for
dates of service on or after Jan. 1, 2010.