CMN Requirement for Oxygen Claims Waived During COVID-19 PHE

WASHINGTON, D.C. (May 12, 2020)—Last week, the DME MACs announced that the certificate of medical necessity (CMN) for oxygen claims will not be required during the public health emergency. This is due to the CMS interim final rule published on April 6 (CMS-1744-IFC) that waived the clinical indication requirements for respiratory NCDs and LCDs. In the new announcement, the DME MACs clarified that the same exemption will apply to external infusion pumps. These changes are effective for dates of service starting March 1, 2020, through the end of the public health emergency.

The DME MACs explained how DME suppliers should file oxygen (and external infusion pump) claims without a CMN:

Suppliers should continue to use the appropriate modifiers, including the KX modifier where applicable, for all HCPCS codes included in the [relevant] NCDs and LCDs. In addition, the CR modifier (CATASTROPHE/DISASTER RELATED) should be added to the HCPCS code(s) billed. Finally, suppliers are instructed to enter “COVID-19” in the NTE 2400 (line note) or NTE 2300 (claim note) segments of the American National Standard Institute (ANSI X12) format or field 390-BM of the National Council for Prescription Drug Program (NCPDP) format. These abbreviations may also be used in Item 19 of the CMS-1500 claim form.

This announcement comes after extensive discussions AAHomecare had with CMS. See the full announcement here.

“This policy change will allow HME suppliers who provide respiratory and infusion services to provide more support to patients and family caregivers during this pandemic,” said Tom Ryan, AAHomecare president and CEO in a press release. “We appreciate CMS’s responsiveness and collaborative approach in modifying regulations to help ensure the HME community can make its strongest possible contribution to limiting the impact of the COVID-19 crisis.”