Oxygen FAQs
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- Please clarify the date of service to be used when billing maintenance and service for oxygen. Does the date of service have to be the actual date of the visit? For example: The beneficiary has oxygen stationary equipment that "capped out" on 12/01/08 which would make the first allowable maintenance and service billable on 07/01/09. However, the equipment has been serviced on 06/15/09. May a supplier bill for the 06/15/09 M&S visit on 07/01/09 or do they have to wait until maintenance is required again?
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The 2009 6-month maintenance and servicing payment for oxygen concentrators and transfilling equipment only applies when the supplier physically makes an in-home visit to inspect the equipment and the date of the visit falls on or after the 6 month anniversary date. In the example provided, the supplier would not be able to bill for an M&S payment on 7/1/09 for a service visit that occurred on 6/15/09. In this particular case, if the supplier physically makes another in-home visit to inspect the equipment between 7/1/09 and 12/31/09, they would be eligible to bill for the 6 month M&S payment. The date of service on the claim would be the date of the actual visit.
Originally published: 10.08.09
Reviewed: 06.23.20
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- If a beneficiary is past the 36 month rental period for oxygen equipment (i.e., payment for the equipment has capped) and the beneficiary has a stationary concentrator, stationary liquid tank, and portable liquid cylinders in the home, what code(s) may be billed?
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Per the Oxygen Policy Article
: If the beneficiary has a stationary concentrator, portable liquid equipment, and a stationary liquid tank to fill the portable cylinders, when payment for contents begins, payment will only be made for the portable liquid contents code. In this situation, payment would not be made for the stationary liquid contents because the stationary tank is just used to fill the portable cylinders.Originally published: 10.08.09
Reviewed: 06.23.20
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- If the required practitioner re-evaluation is not performed within 90 days prior to recertification but is performed at a later date, what should be entered as the Recertification Date on the Oxygen CMN?
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In that situation, the date of the last practitioner visit should be entered as the Recertification Date on the CMN.
For more information, please refer to the Oxygen and Oxygen Equipment
LCD.Originally published: 10.08.09
Reviewed: 06.23.20
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- Is hypoxia a good diagnosis for ordering oxygen?
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The National Coverage Determination (NCD) for oxygen does not have an approved diagnosis list for oxygen coverage. However, there has to be a specific disease that affects the lungs and/or oxygen levels in the blood. Hypoxia is the result of a disease but is not an actual diagnosis. The NCD for oxygen lists examples of what would be considered acceptable for "hypoxia-related symptoms or findings that might be expected to improve with oxygen therapy". The examples provided include pulmonary hypertension, recurring congestive heart failure due to chronic cor pulmonale, erythrocytosis, impairment of the cognitive process, nocturnal restlessness, and morning headaches.
Originally published: 06.26.17
Reviewed: 06.23.20
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- What is required to show that alternate treatments have been tried and failed in order to qualify for oxygen?
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Oxygen is rarely the first-line treatment for lung conditions. Therefore, per the NCD, the medical records must document that "other forms of treatment (e.g., medical and physical therapy directed at secretions, bronchospasm and infection) have been tried, have not been sufficiently successful, and oxygen therapy is still required".
Originally published: 06.26.17
Reviewed: 06.23.20
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- Can you explain the two scenarios for qualifying for oxygen?
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The beneficiary may qualify for oxygen either during an inpatient hospital stay or as an outpatient but who also is in a chronic stable state. If the beneficiary qualifies during an inpatient hospital stay, the O2 saturation should be within two days of discharge and the most recent one obtained at that particular qualifying condition. If the beneficiary qualifies as an outpatient, they must be in a chronic stable state, meaning the O2 saturation cannot be obtained during an acute exacerbation of the lung condition or during an acute respiratory condition/infection.
Originally published: 06.26.17
Reviewed: 06.23.20
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