(Medicare Claims Processing Manual)

The stationary oxygen QF and QB fee schedule amounts on the DMEPOS fee schedule file represent 100 percent of the stationary oxygen allowed fee schedule amount. The portable oxygen equipment add- on QF and QB fee schedule amount on the file by state represent the higher of:   1. 50 percent of the monthly stationary oxygen payment amount (codes E0424, E0439, E1390 or E1391); or   2. The fee schedule amount for the portable oxygen add- on (codes E0431, E0433, E0434, E1392 or K0738).  D. Conserving Device Modifier  The HHA's and suppliers must indicate if an oxygen conserving device is being used with an oxygen delivery system by using HCPCS modifier QH.  E. DME MACs Only  For all States that have licensure/certification requirements for the provision of oxygen and/or oxygen related products, DME MACs shall process claims for oxygen and oxygen related products only when an oxygen specialty code is assigned to the DMEPOS supplier by the NSC and is forwarded to the DME MACs from the NSC. This specialty shall be licensed and/or certified by the State when applicable.  This specialty shall bill for Medicare -covered services and/or products when State law permits such entity to furnish oxygen and/or oxygen related products.  130.6.1 - Oxygen Equipment and Contents Billing Chart  (Rev. 1, 10- 01-03) The following chart indicates what oxygen fee schedule component is billable/payable under various transaction scenarios for providers and suppliers:  1. Situation:  Beneficiary Uses a Stationary System Only  a. Rental Cases (Beneficiary Uses a Stationary System Only)  Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Concentrator  Yes No No No Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee   E1377  E1378 E1379 E1380 E1381 E1382 E1383 E1384 E1385 E1400 E1401 E1402 E1403 E1404 E1405 E1406       Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Gaseous  Yes No No No  E0424    Liquid Yes No No No  E0439    b. Purchase Cases (Beneficiary Uses a Stationary System Only)  Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Concentrator  No No No No Gaseous  No Yes No No   E0441   Liquid No Yes No No   E0442   2. Situation:  Beneficiary Uses Both a Stationary and Portable System    a. Rents Stationary/Rents Portable  Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Concentrator  Yes No Yes No  E1377  E1378 E1379 E1380 E1381 E1382 E1383 E1384 E1385 E1400 E1401 E1402 E1403 E1404  E1405 E1406   E0431 E0434  Gaseous  Yes No Yes No  E0424  E0431  Liquid Yes No Yes No  E0439  E0434     b. Rents Stationary/Owns Portable  Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Concentrator  Yes No No No  E1377  E1378 E1379 E1380 E1381 E1382 E1383 E1384 E1385 E1400 E1401 E1402 E1403 E1404 E1405 E1406     Gaseous  Yes No No No  E0424    Liquid Yes No No No  E0439       c. Owns Stationary/Owns Portable  Type of System   Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Concentrator  No No No Yes     E0443  E0444  Gaseous  No Yes No No   E0441   Liquid No Yes No No   E0442   d. Owns Stationary/Rents Portable  Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Concentrator  No No Yes Yes    E0431  E0434  E0443  E0444  Gaseous  No Yes Yes No   E0441 E0431  Liquid No Yes Yes No   E0442 E0434  3. Situation:  Beneficiary Uses a Portable System Only  a. Rents Portable System (Beneficiary Uses a Portable System Only)  Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Gaseous  No No Yes Yes    E0431 E0443 Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Liquid No No Yes Yes    E0434 E0444 b. Owns Portable System (Beneficiary Uses a Portable System Only)  Type of System  Stationary Monthly Payment  Oxygen Content Fee  Portable Add-On Portable Contents Fee  Gaseous  No No No Yes     E0443 Liquid No No No Yes     E0444  NOTE:   For HHAs revenue codes 0601, 0602, 0603, and 0604 may apply when billing for oxygen under the situations in this chart.  130.7 - Billing for Maintenance and Servicing (Providers and Suppliers)  (Rev. 1, 10- 01-03)  A3-3629   General   Payment is not made for maintenance and servicing if the beneficiary rents the equipment since payment for maintenance and servicing are included in the rental payments.  An exception to this is the 6- month service fee for capped rental items that the beneficiary has elected not to purchase (see 40.2 and 130.5).   Where purchase is permitted (including "Capped Rental Items" and where the beneficiary elects to purchase), payment for reasonable and necessary maintenance and servicing is made for such purchased equipment.  Coding to Identify Maintenance and Servicing   Capped Rental   If the service is capped rental, suppliers that bill the DME MAC for the maintenance and servicing fee (see 40.2) use modifier - MS with the HCPCS code for the equipment to show that parts and labor which are not covered under any manufacturer or supplier warranty.   The HHAs that bill the A/B MAC (HHH) for maintenance and servicing of capped rental items  use revenue code 0299 along with the appropriate HCPCS code for the equipment.   Not Capped Rental   Suppliers that bill the DME MACs for maintenance and servicing indicate the HCPCS code of the item serviced and the modifier - RP, replacement or repair.   The HHAs that bill A/B MACs (HHH) for maintenance and servicing use revenue code 0299 and the appropriate HCPCS code for the equipment serviced.   Hospitals  report revenue code 0274 along with one of the following HCPCS codes: L4205, L4210, L7500, L7510, or L7520 when billing the A/B MAC (A) for maintenance and servicing of prosthetics and orthotics.   130.8 - Installment Payments (Rev. 1, 10- 01-03)  A3-3629   Where a beneficiary is purchasing an item through installments, the total price of the equipment item is reported  on the first bill.  Monthly payments are made (by the A/B MAC (A), (B), (HHH), or DME MAC).  The monthly amount is equivalent to the rental fee schedule amount and is paid until the fee schedule purchase price or actual charge has been reached, whichever comes first.   130.9 - Showing Whether Rented or Purchased  (Rev.  4052, Issued: 05- 17-18, Effective: 10- 01-18, Implementation: 10- 01-18)   Claims must specify whether equipment is rented or purchased. For purchased equipment, the itemized bill or claim must also indicate whether equipment is new or used. If the provider or supplier fails to indicate on an assigned claim whether equipment was new or used, the MAC processing the claims assumes purchased equipment is used and process the claim accordingly, i.e., they pay on the basis of the used purchase fee. If an unassigned purchase claim does not specify whether the item was new or used, MACs develop the claim with the supplier. The following table indicates the HCPCS modifiers which are added to the equipment code to indicate its status: Modifier  Status  -BP  The beneficiary has been informed of the purchase and rental options and has elected to purchase the item  -BR  The beneficiary has been informed of the purchase and rental options and has elected to rent the item  -BU  The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision  -KH  DMEPOS item, initial claim, purchase or first month rental (no longer required for purchased (NU modifier claims) on or after 10/1/18)  -KI  DMEPOS item, second or third month rental  -KJ  DMEPOS item, PEN pump or capped rental months four to fifteen  -NR  New when rented (use the 'NR' modifier when an item that was new at the time of rental is subsequently purchased)  -NU  New equipment  -RR  Rental (use the 'RR' modifier when DME is to be rented)  -UE  Used durable medical equipment (no longer requires the KH modifier for claims submitted on or after 10/1/18)     HHAs report the appropriate modifier using the ASC X12 837 institutional claim format, or Form CMS -1450 following the appropriate HCPCS code.  A/B MACs (HHH) accept 7 positions in this field for data entry purposes.   140 - Billing for Supplies  (Rev. 1, 10- 01-03)    140.1 - Billing for Supplies and Drugs Related to the Effective Use of DME  (Rev. 10236, Issued: 07 -31-2020, Effective: 08 -31-2020, Implementation: 08- 31-2020)    Suppliers and providers bill supplies that are necessary for the effective use of DME, including drugs, with the appropriate HCPCS code identifying the supply.  HHAs must also report revenue code 0294, "Supplies/Drugs for DME Effectiveness."   Suppliers and providers, other than HHAs, bill supplies and drugs (not including drugs that are necessary for the effective use of implanted DME) that are necessary for the effective use of DME to the DME MACs.  HHAs bill the A/B MACs (HHH).   Suppliers and providers, other than HHAs, bill for drugs that are necessary for the effective use of implanted DME (HCPCS codes E0751, E0753, E0782, and E0783) to the A/B MAC (B).  HHAs bill the A/B MAC (HHH).   The A/B MACs (HHH) contact the DME MAC or A/B MAC (B) as necessary to determine drug prices.   The DME MACs must:    accept NDC codes for all drugs billed in the NCPDP format;    accept NDC codes for oral anti -cancer drugs billed in the ASC X12 837 professional claim format, NCPDP format, and paper Form CMS -1500;    accept HCPCS for all other drugs billed in the ASC X12 837 professional claim format  and paper Form CMS -1500 and   return as unprocessable claims submitted with an invalid NDC using the appropriate Remittance Advice Remark Code..   See the official Washington Publishing Company website for a current list of the Remittance Advice Remark Codes.   140.1.1 - Supplier Payment Under Medicare Part B for Insulin Furnished Through Durable Medical Equipment  (Rev. 12013; Issued: 05- 02-23; Effective: 07 -01-23; Implementation: 07 -03-23)  Section 1833(b) of the Social Security Act (the Act) is amended by Section 11407 of the Inflation Reduction Act, which waives the Medicare Part B deductible beginning July 1, 2023 for insulin furnished through an item of durable medical equipment covered under section 1861(n) of the Act. Also, Section 1833(a) of the Act is amended by Section 11407 of the Inflation Reduction Act, which requires that beneficiary coinsurance for a months supply of insulin furnished through an item of durable medical equipment  is not to exceed $35 beginning July 1, 2023. The supplier payment is to be adjusted as necessary so that Medicare pays for the rest of the amount for the months supply of insulin.