Inogen gets its wish: Medicare coverage

Thursday, March 31, 2005

SANTA BARBARA, Calif. -- The Inogen One portable concentrator now has its own K code and providers can use it for billing starting April 1.
Inogen officials see the new K0671 code designation as a victory for new generation oxygen systems because CMS has validated the company's portable oxygen technology.
"This is great news, especially for providers," said CEO Kathy Odell. "Credit should be given to each of the DMERCs and the SADMERC who demonstrated a willingness to evaluate an emerging oxygen technology within a rapidly changing marketplace."
After months of lobbying hard for its own code, Inogen received word from CMS in December that the Inogen One met the criteria for both an oxygen concentrator and a portable gaseous oxygen system as defined by the DMERC Policy for Oxygen and Oxygen Equipment. Based on that guidance, the company started shipping the nine-and-a-half pound unit and providers were instructed to bill using E0431 for the portable add-on in lieu of the new K code. While the K0671 code replaces E0431, providers may also use E1390 to bill for the stationary component.
"Our customers were optimistic that we'd see a K code, but of course the process is complicated and because some products haven't gotten them, we had some concern," said Joe Lewarski, Inogen vice president of clinical and government affairs. "Some of that concern was alleviated when we were classified as E1390 and E0431, however."
Lewarski attributed the swift approval to the Inogen One's budget neutral status, meaning it won't have an adverse effect on the cost of providing the therapy.
"The good news for us is that providers are now getting paid adequately for the performance of the product," he said. "In a perfect world we'd get paid more for new technology, but this is about all we could hope for within the confines of the current system."
Under the modality neutral model, all portable and stationary systems are covered in the same floor and ceiling range even if they have different codes. Though the amounts may change depending on the 2005 FEHBP review, the current range for the E1390 is $194.45 to $228.80 for stationary and the K0671 and E0431 are $30.57 to $35.97 for portable.



Per doctor's direction, I am using oxygen 24/7.  I use a stationary oxygen generator for indoor aplicaton and a small bottle for outdoors. I have Medicare and Tricare for Life.   Am I eligible for a portable generator in lieu of bottles?