Daily CMS NEWS: January 2009

Saturday, January 31, 2009

DME MAC A News for January 31, 2009 - DME MAC Jurisdiction A Test Your Knowledge - Appeals Quiz Now Available

NHIC, Corp.DME MAC A ListServe

For Immediate Release

January 31, 2009
DME MAC Jurisdiction A Test Your Knowledge - Appeals Quiz Now AvailableIn an effort to continue to enhance our educational efforts, DME MAC Jurisdiction A is pleased to announce the addition of a new Test Your Knowledge quiz. The new quiz, Appeals, poses questions on the appeals process. After completing the quiz users will be directed to the correct answers along with a short description of where they can locate more information on the appeals process. The results will also be used to detect educational needs among the supplier community and on an individual basis.If you have been billing Medicare for years or are just starting out, stop by the DME MAC A Web site today and Test Your Knowledge! You may qualify for individual, one-on-one education by one of our Outreach Specialists.The new Appeals Test Your Knowledge quiz can be found on the DME MAC A Web site at:
http://www.medicarenhic.com/dme/dme_quiz_index.shtml

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Friday, January 30, 2009

Palmetto GBA E-mail Update

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CMS Announces Regulatory Revisions Pertinent to Suppliers of Durable

Medical Equipment, Prosthetics, Orthotics and Supplies

http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~National%20Supplier%20Clearinghouse~Articles~General~CMS%20Announces%20Regulatory%20Revisions%20Pertinent%20to%20Suppliers%20of%20Durable%20Medical%20Equipment%20Prosthetics%20Orthotics%20and%20Supplies?opendocument

CMS Releases Change Request 6282 Announcing Regulatory Revisions for DMEPOS

suppliers.

Applies to:

National Supplier Clearinghouse (NSC)//General - NSC

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PalmettoGBA.com Navigation Enhancement

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The PalmettoGBA.com site just got easier to navigate! We have improved our

Web site navigation to help you find information quickly and easily.

Applies to:

General//Web Site Announcements

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Palmetto GBA sent this e-mail to you because your Member Profile indicates

that you want to receive information from us for these listserv(s):

DMERC Region C//Electronic Data Interchange (EDI)

DMERC Region C//FAQs

DMERC Region C//General - DMEPOS

DMERC Region C//Home Care Equipment Supplies

DMERC Region C//Orthotics and Prosthetics

DMERC Region C//Oxygen

DMERC Region C//Pharmacies

DMERC Region C//Power Mobility

DMERC Region C//Respiratory

General//Statistical Analysis DME (SADMERC)

General//Vendors Clearinghouses and Billing Services

General//Web Site Announcements

National Supplier Clearinghouse (NSC)//General - NSC

Jurisdiction C EDI//JCEDI

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DME MAC A News for January 30, 2009 - Weekly Updates

NHIC, Corp.DME MAC A ListServe

For Immediate Release

January 30, 2009

Weekly What's New

The following publications have been posted to the DME MAC A What's New page:Wide Spread Quarterly Review Results - Glucose Supplies HCPCS A4253, A4258, A4259

Medicare Billing Requirements and Policies for Replacement of Oxygen Equipment and Oxygen Contents (CMS Message 2009-01-28)

Medicare Remit Easy Print (MREP) Version 2.5 (CEDI Message 2009-01-22)

Claim Status Category Code and Claim Status Code Update (MM6325)

New and Updated Frequently Asked Questions (FAQs) are now available
For more information visit:

http://www.medicarenhic.com/dme/dme_whats_new.shtml

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DME MAC A News for January 30, 2009 - Join the Medicare Contractors at the Medtrade Exposition

NHIC, Corp.DME MAC A ListServe

For Immediate Release

January 30, 2009
Join the Medicare Contractors at the Medtrade Exposition!The Medtrade Expo will be held from March 24-26, 2009 at the Las Vegas Convention Center in Las Vegas, Nevada. Staff from each of the four Durable Medical Equipment Medicare Administrative Contractors (DME MACs), National Supplier Clearinghouse (NSC), Common Electronic Data Interchange (CEDI) contractor, and the Competitive Bidding Implementation Contractor (CBIC), will be among the many exhibitors available to provide information and address questions. Make sure to visit the Medicare Contractors in booth number 932. The DME MACs departments will also provide an one-hour "Medicare Updates" presentation on March 26th from 9:45 - 10:45 am.Medtrade Spring 2009
Las Vegas Convention Center
Las Vegas, Nevada
Expo - March 25-26, 2009
Conference - March 24-26, 2009Expo Hall Hours
Wednesday, March 25th 11:00am - 5:00pm
Thursday, March 26th 11:00am - 3:00pmVisit http://www.medtrade.com to learn more about the Pre-Show Conferences and other events taking place at this year Medtrade Spring.

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EDI News: E-Commerce Connection newsletter is now available

National Government Services' January 2009 publication of the "E-Commerce Connection" newsletter is now available on our Web site at:

Part A: http://www.ngsmedicare.com/ngsmedicare/PartA/NewsandPublications/ECommerce/connections.aspx Part B: http://www.ngsmedicare.com/ngsmedicare/PartB/NewsandPublications/Ecommerce/Connections.aspx DME MAC: http://www.ngsmedicare.com/ngsmedicare/DMEMAC/NewsandPublications/Ecommerce/Connections.aspx RHHI: http://www.ngsmedicare.com/ngsmedicare/RHHI/NewsandPublications/Ecommerce/Connections.aspx This electronic data interchange (EDI) online newsletter, created by the E-Commerce Consultants, includes updates for all of the states serviced by National Government Services. Through the E-Commerce Connection, electronic data interchange (EDI) information is readily available for electronic submitters, software vendors, billing services and clearinghouses.

In this publication you will: Receive EDI updatesObtain new Resources and Helpful LinksHave the Ability to Ask a question to the EDI Help Desk that will be published in the April E-Commerce ConnectionAnd much more... National Government Services values your feedback. Please be sure to complete the feedback survey regarding the E-Commerce Connection on the last page of the newsletter.

The next issue is scheduled for April 2009.

Remember! National Government Services' EDI List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you!

CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message.

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Jurisdiction B News: Website registration process

Attention Providers:The website registration process has changed and is available at: http://www.ngsmedicare.com To register for a session:Choose Business type and Region and click GOClick Education and Support and then click Events CalendarChoose the month of the session, then click on the session you wish to attendOn the right side of Events Details is a Register Button Click the register button and complete registration form. Review the information you provided on second screen and then submit. The web site will automatically send you a confirmation email that you have been registered providing you entered a valid email address.Please make sure your email accepts incoming messages from NGSMEDICARE

Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you!

CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message.

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DME MAC A News for January 30, 2009 - DME MAC Jurisdiction A Winter Webinar Schedule Reminder

NHIC, Corp.DME MAC A ListServe

For Immediate Release

January 30, 2009
DME MAC Jurisdiction A Winter Webinar ScheduleThe DME MAC Jurisdiction A Outreach & Education Team still has the following FREE educational Webinar sessions open for registration.

All times Eastern Standard
February 3, 2009 from 9:30am - 11:30am
Hospital Bed Billing

February 3, 2009 from 1:30pm - 3:30pm
Oxygen and Oxygen Equipment Billing - Session Full

February 5, 2009 from 9:30am - 11:30am
Advance Beneficiary Notice of Noncoverage (ABN) - Session Full

February 5, 2009 from 1:30pm - 3:30pm
Positive Airway Pressure (PAP) Device Billing - Session Full

February 12, 2009 from 9:30am - 11:30am
Troubleshooting Claim Submission Errors (CSEs) and Denials - Session Full

February 12, 2009 from 1:30pm - 3:30pm
Oxygen and Oxygen Equipment Billing - Session Full

February 17, 2009 from 9:30am - 11:30am
DME MAC Essentials I - Session Full

February 17, 2009 from 1:30pm - 3:30pm
DME MAC Essentials II

February 19, 2009 from 9:30am - 11:30am
Urological Billing

February 19, 2009 from 1:30pm - 3:30pm
Hospital Bed Billing

February 24, 2009 from 9:30am - 11:30am
Positive Airway Pressure (PAP) Device Billing

February 24, 2009 from 1:30pm - 3:30pm
Troubleshooting Claim Submission Errors (CSEs) and Denials - Session Full

February 26, 2009 from 9:30am - 11:30am
Oxygen and Oxygen Equipment Billing - Session Full

February 26, 2009 from 1:30pm - 3:30pm
Advance Beneficiary Notice of Noncoverage (ABN)

March 10, 2009 from 9:30am - 11:30am
DME MAC Essentials I

March 10, 2009 from 1:30pm - 3:30pm
DME MAC Essentials II

March 12, 2009 from 9:30am - 11:30am
Troubleshooting Claim Submission Errors (CSEs) and Denials

March 12, 2009 from 1:30pm - 3:30pm
Hospital Bed Billing

March 17, 2009 from 9:30am - 11:30am
Positive Airway Pressure (PAP) Device Billing

March 17, 2009 from 1:30pm - 3:30pm
Oxygen and Oxygen Equipment Billing

March 19, 2009 from 9:30am - 11:30am
Advance Beneficiary Notice of Noncoverage (ABN)

March 19, 2009 from 1:30pm - 3:30pm
Urological BillingFor further details please visit the "Events/Seminars" section of the DME MAC A Web site at: http://www.medicarenhic.com/dme/dmerc_seminars.shtml

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NAS DME Update

NAS DME Jurisdiction D E-mail List

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Mobility Devices

Wheelchair Options and Accessories Workshop

If you have questions regarding the billing of wheelchair options and accessories, attend one of the workshops NAS is offering.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFEZpkAEBiYXdpjE&tmpl=dme_viewnews&style=part_ab_viewnews

Oxygen

Medicare Billing Requirements and Policies for Replacement of Oxygen Equipment and Oxygen Contents

This joint signature memorandum/technical direction letter (JSM/TDL) provides instructions for processing claims for oxygen and oxygen equipment following the enactment of MIPPA.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?pdf=/provider/updates/docs/Medicare Billing Requirements and Policies for Replacement of Oxygen Equipment and Oxygen Contents.pdf

General Announcements

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Documentation Prior to DME Claim Submission

Attention all suppliers! Join NAS provider outreach and education staff for a 90-minute workshop on documentation prior to claim submission.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFEZpFlpYMVqsqpJ&tmpl=dme_viewnews&style=part_ab_viewnews

Advance Beneficiary Notice of Noncoverage

Do you have questions on when to use an Advance Beneficiary Notice of Noncoverage (ABN)? Did you know the revised ABN (CMS-R-131) is the only acceptable ABN form after March 1, 2009? Join us for a 60-minute workshop on the proper use of an ABN. Follow along as we give step by step instructions on completing the revised ABN.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFEZpuVVkrJjXPnN&tmpl=dme_viewnews&style=part_ab_viewnews

Medicare DMEPOS Competitive Bidding Program Announcements

The Centers for Medicare & Medicaid Services (CMS) has announced that an Interim Final Rule with Comment Period, which implements certain provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Acquisition Program, is on display at the Federal Register.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFEZpylkgwpHVJDj&tmpl=dme_viewnews&style=part_ab_viewnews

CSI and Be Medicare System Security Semi-Annual Review

In accordance with CMS regulations, NAS is required to perform a periodic review of system access for all Claims Status Inquiry (CSI) and Beneficiary Eligibility (BE) users.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFEZplFkDwFBnfDI&tmpl=dme_viewnews&style=part_ab_viewnews

Recent Web Site Enhancements

NAS DME has recently made several improvements to our Web site to provide additional resources and to reduce the number of pages suppliers need to review to find information.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFEZpAyFzuyzUPgX&tmpl=dme_viewnews&style=part_ab_viewnews

Refunds to Medicare Form - Instructions for Completion

Instructions are provided for filling out the Refunds to Medicare form in order for NAS to process refunds efficiently.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?pdf=/provider/updates/docs/Refunds to Medicare Form.pdf

DMEPOS Accreditation Deadline is September 30, 2009

CMS encourages suppliers to submit accreditation applications by January 31, 2009 in order to receive an accreditation decision by the September 30, 2009 deadline.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFElEyEuzcXHhWUH&tmpl=dme_viewnews&style=part_ab_viewnews

Jurisdiction D Happenings, Issue 18, Now Available

Jurisdiction D Happenings, Issue 18, is found on our DME Web site in the News/Publications section in a PDF format.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFElElkFLbcvNSuR&tmpl=dme_viewnews&style=part_ab_viewnews

NAS DME Responses to Survey Comments

NAS DME appreciates and reviews all supplier comments provided on the ForeSee Results Web site satisfaction survey. The following responses give locations of information on our site and other Web sites based on survey comments received in December 2008.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFElklZZUDgyVSwS&tmpl=dme_viewnews&style=part_ab_viewnews

MREP Updated for Remittance Code Changes

The Medicare Remit Easy Print (MREP) software has been modified to include the remittance advice remark and claim adjustment reason codes updates as outlined in MLN Matters 6229.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFElFkEZPQRYTVvd&tmpl=dme_viewnews&style=part_ab_viewnews

HHS Issues Final ICD-10 Code Sets and Updated Electronic Transaction Standards Rules

The U.S. Department of Health and Human Services (HHS) recently released two final rules that will facilitate the United States' ongoing transition to an electronic health care environment through adoption of a new generation of diagnosis and procedure codes and updated standards for electronic health care and pharmacy transactions.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFElFFVlhhvAblgz&tmpl=dme_viewnews&style=part_ab_viewnews

Replacement - RA Modifier Clarification

NAS has seen an increase in claims where the RA modifier is used inappropriately. The RA modifier is described as replacement of a DME item, due to loss, irreparable damage, or when the item has been stolen.

Read the complete update: https://www.noridianmedicare.com/lsredir.php?id=EkFFElFyykBydWeiUk&tmpl=dme_viewnews&style=part_ab_viewnews

Claim Status Category Code and Claim Status Code Update MLN Matters 6325

Change Request (CR) 6325, from which this article is taken, reminds providers of the periodic updates to the Claim Status Codes and Claim Status Category Codes that Medicare contractors use with the Health Care Status Request (ASC X12N 276), and the Health Care Claim Response (ASC X12N 277).

Read the complete update: https://www.noridianmedicare.com/lsredir.php?pdf=/provider/updates/docs/MM6325.pdf

Thursday, January 29, 2009

Jurisdiction B News: IPPE Resource Available in Laminated Chart or Tear Off Pad

IPPE Resource Now Available in a Laminated Chart or Tear Off Pad (200901-49) This message is slightly different from the one earlier this week as this one announces the product availability in either a laminated chart or tear off pad The ABC's of Providing the Initial Preventive Physical Examination Quick Reference Information (January 2009 Resource). This resource tool is now available in either a two-sided laminated chart or in a tear off pad. It can be used by Medicare fee-for-service physicians and qualified non-physician practitioners as a guide when providing the initial preventive physical examination (IPPE) (also known as the "Welcome to Medicare" Physical Exam or the "Welcome to Medicare" Visit). The two-sided reference identifies the components and elements of the IPPE; provides eligibility requirements, procedure codes to use when filing claims, FAQs, and suggestions for preparing patients for the IPPE; and lists references for additional information. To view, download and print this resource, please go to the CMS Medicare Learning Network (MLN) at: http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf. To order free of charge the laminated chart or tear off pad, visit http://www.cms.hhs.gov/MLNProducts/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."

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DME MAC Jurisdiction C News

The DME Provider Contact Center will be closed in observance of the Presidents Day holiday on February 16, 2009: Although you will be unable to speak to a Customer Service Representative (CSR) during this time, please remember that our Interactive Voice Response (IVR) unit will remain operational to provide you with information that does not require CSR assistance.

CMN Status for Oxygen: The CMN status option of the DME MAC Jurisdiction C IVR provides CMN information for the procedure code entered and also CMN information on any similar equipment on file; however, at this time the IVR is not able to provide the most accurate CMN information for oxygen codes. Therefore, the Customer Service staff has been instructed to assist suppliers with CMN status for oxygen. All other CMN status inquiries should be conducted through the IVR.

Attention Providers! Don't be left out! Registration for the Savannah, GA workshop is still available! Please join Provider Outreach and Education for the upcoming workshop "Medicare Survival Guide" in Savannah, GA. These all day events provide valuable information on a wide array of Medicare topics to help attendees survive the Medicare world. Topics include:

Medicare Updates
Documentation/Intake process
CERT Reduction Plans: What You Need to Know to Decrease Errors
Top Denials and Inquiries

Thank you for visiting www.cignagovernmentservices.com!

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DME MAC A News for January 29, 2009 - Mid-Week Updates

NHIC, Corp.DME MAC A ListServe

For Immediate Release

January 29, 2009

Mid-Week Update

The following publication has been posted to the DME MAC A What's New page:Elastic Garments - Noncovered
For more information visit:

http://www.medicarenhic.com/dme/dme_whats_new.shtml

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Jurisdiction B News: Join the Medicare Contractors at the Medtrade Exposition!

Join the Medicare Contractors at the Medtrade Exposition! The Medtrade Spring Conference and Expo is the leading event in the home medical equipment industry. It offers nearly 400 exhibitors showcasing the latest Home Medical Equipment (HME) products and services in the market. Attend conferences lead by industry professionals all guided toward helping you make smart decisions about the issues you are facing in today's business environment. Also, this is your chance to network with other HME professionals and create new business relationships. The Medtrade Expo will be held from March 24-26, 2009 at the Las Vegas Convention Center in Las Vegas, Nevada. Staff from each of the four Durable Medical Equipment Medicare Administrative Contractors (DME MACs), National Supplier Clearinghouse (NSC), Common Electronic Data Interchange (CEDI) contractor, and the Competitive Bidding Implementation Contractor (CBIC), will be among the many exhibitors available to provide information and address questions. Make sure to visit the Medicare Contractors in booth number 932. The DME MACs departments will also provide an one‐hour "Medicare Updates" presentation on March 26th from 9:45 - 10:45 am. Medtrade Spring 2009Las Vegas Convention CenterLas Vegas, NevadaExpo - March 25-26, 2009Conference - March 24-26, 2009 Expo Hall HoursWednesday, March 25th11:00am - 5:00pmThursday, March 26th 11:00am - 3:00pm Attend the Medtrade Spring Conference sessions for ONLY $99 and also receive CEUs for any sessions in the Oxygen & Respiratory Issues track and the Rehabilitation & Assistive Technology track! Visit www.medtrade.com to learn more about the Pre-Show Conferences and other events taking place at this year Medtrade Spring.

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New Medicare Front End Reports start today

Dear DMEFree / RxDME2000 Clearinghouse provider;

Medicare and Cedi are getting ready for the January 30th conversion from the 'old' DMAC front end reports to the 'new' Cedi Gen Report.

I have attached the current copy of the Cedi reports manual to this email, it is also available at;

http://www.ngscedi.com/outreach_materials/CEDIFrontEndReportsManual.pdf

During phase I the DMACs were sending back their front reports with the CCN# (claim control number). During phase II (Jan 30th) it will be Cedi's responsibility to do the front end editing and issuing the CCN#. If a claim has a CCN# , then it goes to Medicare for adjudication.

Cedi didn't have a software program to separate the hundred's of individual reports returned to us in one file. That is the job of this clearinghouse, We wanted to retain the report format to match the Cedi manual, with one exception.

At the end of every report is a "glossary" of the errors with full explanation. Our reason for doing this is to save you time and avoid the nightmare of having to understand what loops and segments are.

If you have any questions regarding these new reports send us an email support@dmefree.com

Thank you

Mike Feldman

PCSolutions

www.dmefree.com

fax 860 974 1886

Jurisdiction B News: Billing Requirements & Policies for Replacement Oxygen

Medicare Billing Requirements and Policies for Replacement of Oxygen Equipment and Oxygen Contents (200901-48)

This message is for suppliers and home health agencies that furnish oxygen and oxygen equipment to Medicare beneficiaries

Suppliers of oxygen and oxygen equipment need to be aware of the procedures for submitting claims for oxygen and oxygen equipment following the enactment of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) on July 15, 2008.

Section 144(b) of MIPPA took effect on January 1, 2009, and repeals the requirement for you to transfer title to oxygen equipment to the beneficiary after the 36 month payment cap mandated by the Deficit Reduction Act of 2005. Section 144(b) of MIPPA also establishes new payment rules and supplier responsibilities following the 36 month payment period. See Medicare Learning Network -MLN Matters number SE0840 for additional information about these new rules. This listserv message provides specific instructions for submitting claims for oxygen contents and replacement of oxygen equipment.

REPLACEMENT OF OXYGEN EQUIPMENT

New HCPCS Modifier for Replacement of DME

Effective January 1, 2009, the following modifiers was added to the Healthcare Common Procedure Coding System (HCPCS):

RA - Replacement of a DME item;

This modifier is to be used on claims for replacement of oxygen equipment with dates of service on or after January 1, 2009. HCPCS modifier RP, which was discontinued effective December 31 2008, remains in effect for claims with dates of service prior to January 1, 2009.

If oxygen equipment is replaced because the equipment has been in continuous use by the patient for the equipment's reasonable useful lifetime or is lost, stolen, or irreparably damaged, the patient may elect to obtain a new piece of equipment. Irreparable damage refers to a specific incident of damage to equipment such as equipment falling down a flight of stairs as opposed to equipment that is worn out over time. In these situations, a new 36-month rental period and new reasonable useful lifetime is started on the date that the new, replacement item is furnished. Claims for the replacement of oxygen equipment for the first month of use only are billed using the HCPCS code for the new equipment and either the RA or RP HCPCS modifier depending on the date that the equipment is furnished.

You must include on the claim for the first month of use a narrative explanation of the reason why the equipment was replaced and supporting documentation must be maintained in your files. For example, if equipment is stolen, you should keep a copy of the police report in your files. For lost or irreparably damaged equipment, you should maintain any documentation that supports the narrative account of the incident. For reasonable useful lifetime replacements, the narrative explanation should include the date that the beneficiary received the equipment being replaced.

When submitting claims electronically for replacement of oxygen equipment, you may use, for the narrative explanation, loop 2400 (line note), segment NTE02 (NTE01=ADD) of the ASC X12, version 4010A1 professional electronic claim format. If you are billing using the Form CMS-1500 paper claim, you may report this information in item 19 of the claim form.

If you are a home health agency submitting claims electronically for replacement of oxygen equipment, you may use, for the narrative explanation, loop 2300, segment NTE (billing note) of the ASC X12, version 4010A1 institutional electronic claim format. If you are a home health agency billing using the UB-04 paper claim, you may report this information in Form Locator 80 (Remarks).

A new certificate of medical necessity (CMN) is required in situations where oxygen equipment is replaced because the equipment has been in continuous use by the patient for the equipment's reasonable useful lifetime or is lost, stolen, or irreparably damaged. New testing, however, is not required unless it is necessary in order to meet existing medical review guidelines for oxygen and oxygen equipment. You should continue to follow the existing guidelines requiring recertification CMNs for all situations in which oxygen equipment is being replaced. The most recent qualifying value and testing date should be entered on the CMN.

As is the case for all DME items, you must maintain proof-of-delivery documentation in your files for replacement oxygen equipment. In addition, for equipment that is being replaced because it has been in continuous use by the beneficiary for the reasonable useful lifetime and the beneficiary has elected to obtain new equipment, you must also have proof-of-delivery documentation in your files for the item being replaced that documents that the oxygen equipment has been in use for at least 5 years.

Change in Oxygen Equipment during the Reasonable Useful Lifetime Period

The reasonable useful lifetime for stationary or portable oxygen equipment begins when the oxygen equipment is first delivered to the beneficiary and continues until the point at which the stationary or portable oxygen equipment has been used by the beneficiary on a continuous basis for 5 years. Computation of the reasonable useful lifetime is not based on the age of the equipment.

If there is a change in oxygen equipment modalities (e.g., from a concentrator to a stationary liquid oxygen system) prior to the end of the reasonable useful lifetime period, this does not result in the start of a new reasonable useful lifetime period or a new 36 month payment period. In addition, if you have to replace oxygen equipment that is not functioning properly prior to the end of the reasonable useful lifetime period, this does not result in the start of a new reasonable useful lifetime period or a new 36 month payment period. Finally, if the beneficiary switches to a new supplier and new equipment prior to the end of the reasonable useful lifetime period, this does not result in the start of a new reasonable useful lifetime period or a new 36 month payment period.

A beneficiary may elect to obtain new oxygen equipment at the end of the 5 year reasonable useful lifetime period in these situations.

Clarification of Policy Regarding Continuous Use of Oxygen and Oxygen Equipment

The instructions pertaining to payments for capped rental items during a period of continuous use now apply to the monthly payment amounts for oxygen and oxygen equipment and the portable oxygen equipment add-on payments.

A period of continuous use allows for temporary interruptions in the use of the equipment. For breaks in need (beneficiary no longer needs or uses the equipment) of less than 60 days plus the days remaining in the last paid rental month, the period of continuous use does not start over and so the count of continuous months picks up where it left off before the break. For example, if the last paid rental month is month #31 and there is a 50 day break in need, the next paid rental month would be month #32.

If, however, there is a break in need more than 60 days plus the days remaining in the last paid rental month, and the need for the equipment resumes at a later date, a new period of continuous use, a new 36-month payment period, and a new reasonable useful lifetime period would begin provided that you have submitted the following:

New medical necessity documentation (i.e., a new CMN and retesting) for oxygen and oxygen equipment and/or portable oxygen equipment;

AND

A narrative explanation describing the reason for the interruption which shows that medical necessity in the prior episode ended. When submitting claims electronically for replacement of oxygen equipment, you may use, for the narrative explanation, loop 2400 (line note), segment NTE02 (NTE01=ADD) of the ASC X12, version 4010A1 professional electronic format. If you are billing using the Form CMS-1500 paper claim, you may report this information in item 19 of the claim form. If you are a home health agency submitting claims electronically for replacement of oxygen equipment, you may use, for the narrative explanation, loop 2300, segment NTE (billing note) of the ASC X12, version 4010A1 institutional electronic claim format. If you are a home health agency and are billing using the UB-04 paper claim, you may report this information in Form Locator 80 (Remarks). Suppliers and home health agencies are not to use modifier RA on these claims.

PLEASE NOTE: If medical necessity for the equipment continues during a break in billing/Part B payment (e.g., the beneficiary is hospitalized for 70 days but continues to use oxygen equipment during the hospital stay), this DOES NOT constitute a break in need, and therefore, a new period of continuous use DOES NOT begin. In these situations, the count of continuous months picks up where it left off before the break.

OXYGEN CONTENTS

Payment for Oxygen Contents (General Policy)

If you furnished liquid or gaseous oxygen equipment during the 36-month rental period, you are responsible for furnishing the oxygen contents used with the oxygen equipment for any period of medical need following the 36-month rental cap for the remainder of the reasonable useful lifetime of the equipment.

In these situations, you can bill for and receive a monthly payment for furnishing oxygen contents (see chart below).

Payment for Oxygen Contents (When Monthly Payments May Begin)

Payment for both oxygen contents used with stationary oxygen equipment and oxygen contents used with portable oxygen equipment is included in the 36 monthly payments for oxygen and oxygen equipment (stationary oxygen equipment payment) made for codes E0424, E0439, E1390, or E1391. Beginning with dates of service on or after the end date of service for the month representing the 36th payment for code E0424, E0439, E1390, or E1391, you may bill on a monthly basis for furnishing oxygen contents (stationary and/or portable), but only in accordance with the following chart:

Equipment Furnished in Month 36	Monthly Contents Payment after Stationary Cap
Oxygen Concentrator (E1390, E1391, or E1392)	None
Portable Gaseous Transfilling Equipment (K0738)	None
Portable Liquid Transfilling Equipment (E1399)	None
Stationary Gaseous Oxygen System (E0424)	Stationary Gaseous Contents (E0441)
Stationary Liquid Oxygen System (E0439)	Stationary Liquid Contents (E0442)
Portable Gaseous Oxygen System (E0431)	Portable Gaseous Contents (E0443)
Portable Liquid Oxygen System (E0434)	Portable Liquid Contents (E0444)

You may not bill for stationary oxygen contents if the beneficiary uses a stationary concentrator and you may not bill for portable oxygen contents if the beneficiary uses a portable concentrator or transfilling equipment.

PLEASE NOTE: The descriptors for HCPCS codes E0441 through E0444 reflect older policies and regulations and need to be revised to reflect current policies and regulations. For now, each of these four codes represents monthly delivery of either stationary or portable oxygen contents. The language in parentheses in the descriptors for each of these codes should be disregarded.

If the beneficiary began using portable gaseous or liquid oxygen equipment (E0431 or E0434) more than one month after they began using stationary oxygen equipment, monthly payments for portable gaseous or liquid oxygen contents (E0443 or E0444) may begin following the stationary oxygen equipment payment cap AND prior to the end of the portable equipment payment cap (code E0431 or E0434). As long as the beneficiary is using covered gaseous or liquid portable oxygen equipment, payments for portable oxygen contents may begin following the stationary oxygen equipment payment cap. This will result in a period during which monthly payments for E0431 and E0443, in the case of a beneficiary using portable gaseous oxygen equipment, or E0434 and E0444, in the case of a beneficiary using portable liquid oxygen equipment, overlap. In these situations, after the 36-month portable oxygen equipment payment cap for E0431 or E0434 is reached, monthly payments for portable oxygen contents (E0443 or E0444) would continue.

If the beneficiary began using portable gaseous or liquid oxygen equipment (E0431 or E0434) following the 36-month stationary oxygen equipment payment period, payments may be made for both the portable equipment (E0431 or E0434) and portable contents (E0443 or E0444).

In all cases, separate payment for oxygen contents (stationary or portable) would end in the event that a beneficiary receives new stationary oxygen equipment and a new 36-month stationary oxygen equipment payment period begins (i.e., in situations where stationary oxygen equipment is replaced because the equipment has been in continuous use by the patient for the equipment's reasonable useful lifetime or is lost, stolen, or irreparably damaged). Again, the monthly payment for stationary oxygen equipment includes payment for both stationary and portable oxygen contents. Therefore, under no circumstances can you receive both the monthly stationary oxygen equipment payment and payment for either stationary or portable oxygen contents.

Proof-of-Delivery Requirements for Oxygen Contents

Following the stationary oxygen equipment payment cap, you may bill for oxygen contents (stationary and/or portable in accordance with the chart above) on the anniversary date of the oxygen equipment billing.

For example, if the 36th month of continuous use of the stationary oxygen equipment begins on March 11th and ends on April 10th, you may begin billing for monthly oxygen contents that the beneficiary will use after the cap on April 11th.

For subsequent months, you do not need to deliver the oxygen contents every month in order to continue billing for the contents on a monthly basis. A maximum of 3 months of oxygen contents can be delivered at one time. In these situations, the delivery date of the oxygen contents does not have to be the DOS (anniversary date) on the claim. However, in order to bill for contents for a specific month, you must have previously delivered quantities of oxygen that are sufficient to last for one month following the date of service on the claim. You are required to have proof-of-delivery for each actual delivery of oxygen, but as discussed above, this may be less often than monthly.

For example, if you deliver 30 oxygen tanks on April 11th and the beneficiary only uses 15 tanks from April 11th through May 10th and 15 tanks from May 11th through June 10th, you may bill for contents on April 11th and again on May 11th for contents delivered on April 11th that were used for two months.

A Change Request (CR) and a MLN Matters Article will be forthcoming that will incorporate the information contained in this listserv message.

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