A new capped rental period may begin. Refer to the DME Supplier Manual
for information about replacement and documentation needed for replacement
2. Was the equipment lost, stolen, or irreparably damaged in a specific incident?
Yes No
A new capped rental period may begin. Refer to the DME Supplier Manual for information about replacement and documentation needed for replacement
3. Has the Reasonable Useful Lifetime for the equipment expired?
Yes No
A new capped rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
4. What was the reason for the interruption?
Break in Billing: The supplier is not billing Medicare FFS for the item but there is no change in Medical Necessity. (SNF, Home Health, Medicare Advantage Plan, HMO)
Break in Medical Necessity: There was a resolution of the condition that created the first period of medical necessity and there was subsequent development of a second event that created a new period of Medical Necessity.
A new capped rental period would not begin. If a beneficiary enters a hospital/ SNF or enters Medicare HMO, upon return to FFS Medicare, billing will resume where it left off.
5. Did the break in medical necessity last more than 60 days plus the remainder of the rental month of discontinuation?
Yes No
A new capped rental period would not begin. If need/use of oxygen ends for less than 60 days plus the remainder of the rental month of discontinuation and then resumes, payment resumes where it left off. Oxygen and Oxygen Equipment - Policy Article
6. Did the break in medical necessity occur during the 36-month rental period?
Yes No
A new capped rental period would begin. A treating practitioner’s order is needed to reaffirm the medical necessity of the item. View the associated Policy Article for more information. Oxygen and Oxygen Equipment - Policy Article
A new capped rental period would not begin. During months 37-60, if need/use of oxygen ends for more than 60 days plus the remainder of the rental month of discontinuation and new medical necessity is established, a new rental period does not begin. The supplier who provided the oxygen equipment during the 36th rental month must provide all necessary items and services for the duration of the reasonable useful lifetime. Oxygen and Oxygen Equipment - Policy Article