Budget neutrality dampens certain oxygen reimbursement

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Wednesday, December 19, 2018

WASHINGTON – Reimbursement rates for stationary and portable oxygen concentrators fare quite differently in the 2019 fee schedule, according to an analysis by AAHomecare.

The rural rate for stationary concentrators (E1390) will increase 10.9%, from $121.46 to $134.71, and the average regional rate will increase 4.4% from $69.31 to $72.32.

The rural rate for POCs (E1392) will decrease 5.2% from $46.77 to $44.32, and the average regional rate will decrease 6.5%, from $38.10 to $35.64.

Rates for portable gaseous contents (E0431) and portable gaseous 02 system (K0738) will also see decreases ranging from 3.8% to 6.5%, according to AAHomecare.

“These additional cuts for home oxygen therapy are certain to impact providers and patients in rural and other non-CBA areas,” stated AAHomecare in a bulletin. “Since CMS has repeatedly made it clear that they do not believe they have the statutory authority to address the budget neutrality offset, the HME community needs to make this a priority for advocacy efforts in the 116th Congress.”

A competitive-bidding related final rule released in November creates a new class for portable liquid oxygen equipment by splitting the existing class of portable gas and portable liquid oxygen, and changes the way budget neutrality is calculated by applying the offset to all oxygen and oxygen equipment classes beginning Jan. 1.

CMS’s 2019 fee schedule, released last week, provides a 2.5% increased to single payment amounts in former competitive bidding areas; a 2.5% increase to SPAs for diabetes supplies as part of the mail-order program; and a 2.3% increase for all other DME.