Oxygen cap: CMS releases more details

Sunday, February 1, 2009

WASHINGTON - CMS detailed last week the billing requirements and policies for replacing oxygen equipment after five years and providing oxygen contents. The industry's reaction: It's a day late, and to some, a dollar short.

"In general, I thought it provided clarity on some of the billing issues we've had," said Cara Bachenheimer, senior vice president of government relations for Invacare. "But, really, this should have been out in December. They didn't re-invent the wheel."

CMS's Jan. 27 listserv message came more than three weeks after the 36-month cap on Medicare oxygen reimbursement kicked in Jan. 1.

The industry has known for some time that providers could, with the beneficiary's consent, supply new oxygen equipment after five years, starting a new rental period. But they weren't sure of the logistics. CMS's message instructs providers to submit a claim using the RA modifier; file a new certificate of medical necessity (CMN); and maintain delivery documentation.

One thing CMS doesn't require: new testing.

"That's a huge silver lining," said Kelly Riley, director of The MED Group's Respiratory Network. "We had heard a rumor that CMS was going to require patients be retested. Getting a new CMN is part of a provider's day-to-day business, but getting patients retested would have been the straw that broke the camel's back."

CMS's message also addressed whether providers have to deliver oxygen contents each month to bill for them each month--they don't. They can deliver up to three months' worth of contents at a time.

Even with the message, getting paid for replacing equipment and providing contents may remain a challenge.

"That's the big question," Bachenheimer said. "Because this isn't an official program transmittal, do the DME MACs have their systems programmed to accept claims for replacing equipment and providing contents?"

The message states: "A change request (CR) and an MLN Matters Article will be forthcoming that will incorporate the information contained in this listserv message."

For some industry sources, CMS's message didn't go far enough.

"We feel CMS is still ambiguous, when it comes to changing equipment during the five-year reasonable useful lifetime," said Wayne Stanfield, executive director of NAIMES. "In one sentence, they state that changing equipment doesn't start a new five-year period; in another sentence, their wording implies that it does."

AAHomecare's Walt Gorski seemed to sum up the sentiments of many.

"This information is helpful," said Gorski, vice president of government affairs. "But we continue to work with CMS to seek clarifications and guidance."

To read CMS's message, go here: