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DME MACs provide additional guidance 

DME MACs provide additional guidance 

WASHINGTON – The DME MACs have published an updated FAQ to provide additional guidance related to the new local coverage determination for home oxygen therapy. 

The FAQ comprises 25 questions related to continued need, the new N modifiers and more. 

AAHomecare highlighted the following questions in a bulletin: 

1. Is an initial F2F evaluation required? 
Answer: While there’s no formal requirement in the NCD or LCD, good medical practice would dictate some type of F2F or telehealth evaluation prior to ordering oxygen. 
6. Will a CMN or DIF dated prior to Jan. 1, 2023, still be sufficient to show continued need/use, once CMNs are eliminated? 
Answer: Yes, a CMN (initial, recert, revised) obtained prior to 1/1/23 will be good for one year from the initial, recertified, or revised date on the CMN. 
7. If the N3 modifier for oxygen is used, will the claim automatically deny, or will it suspend for review? 
Answer: The N-modifiers will be required in place of the KX modifier for new oxygen rental periods beginning on or after April 1, 2023. The N3 modifier will be used to identify patients with normal (i.e., ≥90%) oxygen levels who qualify based on their specific diagnosis (e.g., cluster headaches). 
To review all the questions and answers, go here

CMS published a new LCD and policy article in November.  


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