Oxygen and Oxygen Equipment Pre-Pay Review Quarterly Status Report
Below is the analysis of claim denials for oxygen and oxygen equipment HCPCS codes E0424, E0439, E1390 and E1391 reviewed July 1 – September 30, 2024. The error rate for this quarter is 12.92%%. The top 10 reasons for claim denials are as follows:
| Rank | Reason | Percent |
|---|---|---|
| 1. | The medical record documentation does not support the treating practitioner has evaluated the results of a qualifying blood gas study performed. | 37.05% |
| 2. | The medical record documentation does not include a blood gas study. | 15.60% |
| 3. | The medical record documentation does not support any of the Group I criteria. | 15.32% |
| 4. | The documentation does not have a valid order. | 7.80% |
| 5. | The medical record documentation does not support the blood gas study was obtained within two days prior to discharge from an inpatient hospital stay. | 4.74% |
| 6. | The standard written order is missing a description of the item. | 3.90% |
| 7. | The medical record documentation does not support that the qualifying blood gas study was performed at the time of need. | 3.34% |
| 8. | The supplier billed in error. | 3.06% |
| 9. | No medical record documentation was received. | 2.51% |
| 10. | The patient was in an acute care hospital or skilled nursing facility on this date of service. | 1.67% |
*The total percentage will be greater than 100% because some claims denied for multiple reasons.
**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to be an overall error rate for the HCPCS code or policy under medical record review.
Resources:
- Medicare Minute® MD Oxygen and Oxygen Equipment
- Oxygen and Oxygen Equipment: Beneficiaries Meeting Group I & II Criteria – Documentation Checklist

- Oxygen and Oxygen Equipment – LCD (L33797)

- Oxygen and Oxygen Equipment – Policy Article (A52514)

- Oxygen Medical Review Resources
- Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)

- Supplier Manual Chapter 3 – Supplier Documentation

Updated: November 5, 2024

