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.