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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that the reasonable useful lifetime (RUL) for oxygen equipment is 5 years. The RUL is not based 
on the chronological age of the equipment. It starts on the initial date of service and runs for 5 years from that 
date. RUL also does not take into account exchanges of equipment, new suppliers, or changes of modality 
(concentrator, gaseous, liquid). Stationary and portable oxygen equipment is often provided at the same time 
therefore the RUL for both items run concurrently. When the RUL of a beneficiarys portable oxygen 
equipment differs from the RUL of the beneficiarys stationary oxygen equipment, the RUL of the stationary 
oxygen equipment shall govern the application of RUL-based rules and processes for both types, stationary and 
portable, of oxygen equipment. 
 
The rules say that reimbursement for oxygen equipment is limited to 36 monthly rental payments. Payment for 
accessories (e.g., cannula, tubing, etc.), delivery, back-up equipment, maintenance, and repairs is included in 
the rental allowance. Payment for oxygen contents (stationary and/or portable) is included in the allowance for 
stationary equipment (E0424, E0439, E1390, E1391). Payment for stationary equipment is increased for 
beneficiaries requiring greater than 4 liters per minute (LPM) of oxygen flow and decreased for beneficiaries 
requiring less than 1 LPM. If a beneficiary qualifies for additional payment for greater than 4 LPM of oxygen 
and also meets the requirements for portable oxygen, the appropriate modifiers (QB or QF) must be used. 
 
Providing different oxygen equipment/modalities (e.g., concentrator [stationary or portable], gaseous, liquid, 
trans-filling equipment) is not permitted unless one of the following requirements is met: 
 
    a. Supplier replaces the equipment with the same or equivalent item 
    b. Treating practitioners orders different equipment 
    c. Beneficiary chooses to receive an upgrade and signs an Advance Beneficiary Notice of Non-coverage 
(ABN) 
    d. CMS or the DME MAC determines that a change in equipment is warranted 
 
A new 36-month rental period can begin only in the following situations: 
 
    a. Specific incident of damage beyond repair (e.g., dropped and broken, fire, flood, etc.) or the item is stolen 
or lost 
 
    b. Break-in-need for at least 60 days plus the days remaining in the month of discontinuation and new 
medical necessity is established A new 36-month rental period does not start in the following situations: 
 
    a. Replacing equipment due to malfunction, wear and tear, routine maintenance, repair 
    b. Providing different equipment based on a treating practitioner order or beneficiary request for an upgrade 
    c. Break-in-need less than 60 days plus the days remaining in the month of discontinuation 
    d. Break-in-billing  
    e. Changing suppliers 
 
There is no further payment for oxygen equipment during the 5-year reasonable useful lifetime (RUL) of the 
equipment after 36 rental payments have been made. If use of portable equipment (E0431, E0433, E0434, 
E1392, K0738) begins after the use of stationary equipment begins, payment for the portable equipment can 
continue after payment for the stationary equipment ends until 36 rental payments have been made for the 
portable equipment. 
 
The supplier who provided the equipment during the 36th rental month is required to continue to provide the 
equipment, accessories, contents (if applicable), maintenance, and repair of the oxygen equipment during the 5 
year reasonable useful lifetime of the equipment. 
 
You can find this information in the Local Coverage Article, Oxygen and Oxygen Equipment A52514. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.