Reminder: High Liter Flow Oxygen and Oxygen
Equipment Payment and Billing Guidelines
If basic
oxygen coverage criteria have been met, a higher allowance for a stationary
system for a flow rate greater than 4 liters per minute (LPM) will be paid if
coverage criteria outlined in the local coverage determination (LCD) for Oxygen
and Oxygen Equipment are met.
Suppliers
are reminded that the appropriate modifier
must be used if the prescribed flow rate is greater than 4 LPM. These
modifiers may be used only with stationary gaseous (E0424) or liquid (E0439)
systems or with an oxygen concentrator (E1390, E1391). They may
not be used with codes for portable systems or oxygen
contents.
If coverage criteria are met, a portable oxygen system
is usually payable separately in addition to the stationary system. However, if
the prescribed oxygen amount is greater than 4 LPM portable oxygen is
not separately payable; payment for the portable
equipment is included in the higher allowance for the stationary equipment.
Oxygen Equipment Informational
Modifiers:
- QF – Prescribed amount of oxygen is greater than 4 LPM and portable oxygen is also prescribed
- QG – Prescribed amount of oxygen is greater than 4 LPM and portable oxygen is not prescribed
If a
Certificate of Medical Necessity CMS-484 is submitted to the durable medical
equipment Medicare administrative contractor (DME MAC) and question 5
indicates the flow rate ordered for the patient is
greater than 4 LPM, either the QF or QG modifier
must be appended to the HCPCS code for the stationary
liquid or gaseous systems (E0424, E0439) or concentrator (E1390-E1391). If the
QF or QG modifiers are omitted, the claim will be rejected with ANSI code CO-16
for a missing, incomplete, or invalid HCPCS modifier.
Furthermore, if an oxygen claim is submitted with a
Certificate of Medical Necessity CMS-484 and question 5
indicates a flow rate less than 4 LPM, the QF or QG
modifier must not be appended to the HCPCS code for the
stationary liquid or gaseous systems (E0424, E0439) or concentrator
(E1390-E1391); otherwise the claim will be rejected with ANSI code CO-16 for a
missing, incomplete, or invalid HCPCS modifier.
- QE – Prescribed amount of oxygen is less than 1 LPM
If a
Certificate of Medical Necessity CMS-484 is submitted to the DME MAC and
question 5 indicates the flow rate ordered for the patient is
less than 1 LPM, the QE modifier must be appended to the
HCPCS code for the stationary liquid or gaseous systems (E0424, E0439) or
concentrator (E1390-E1391). If the QE modifier is omitted the claim will be
rejected with ANSI CO-16 for a missing, incomplete, or invalid HCPCs modifier.
Furthermore, if an oxygen claim is submitted with a
Certificate of Medical Necessity CMS-484 CMN and question 5
indicates a flow rate greater than 1 LPM and
the QE modifier is appended, the claim will be rejected with ANSI code CO-16 for
incorrect coding.
Additional
information related to oxygen and oxygen equipment can be found in the Oxygen
and Oxygen Equipment Local Coverage Determination and Policy Article. http://apps.ngsmedicare.c...D=51&ContentID=34529
