(Medicare Claims Processing Manual)

 Stationary oxygen contents (for beneficiary -owned stationary liquid or gaseous equipment)    Portable oxygen contents (for beneficiary -owned portable liquid or gaseous equipment)   In cases where a supplier is furnishing both stationary oxygen contents and portable oxygen contents, the supplier is paid both the single payment amount for stationary oxygen contents and the single payment amount for portable oxygen contents.  The payment amounts for purchase of supplies and accessories used with beneficiary -owned oxygen equipment are equal to the single payment amounts established for the supply or accessory.   40.5.1 - Change in Suppliers for Oxygen and Oxygen Equipment  (Rev.  3953, Issued: 01- 19-18, Effective: 07 -01-18, Implementation: 07- 02-18)  The following rules apply when the beneficiary switches from one supplier of oxygen and oxygen equipment to another supplie r after the beginning of each round of competitive bidding:   Noncontract supplier to contract supplier   In general, monthly payment amounts may not exceed a period of continuous use of longer than 36 months.  However, if the beneficiary switches from a noncontract supplier to a contract supplier before the end of the 36- month period, at least 10 monthly payment amounts would be made to a contract supplier that begins furnishing oxygen and oxygen equipment in these situations provided that medical necessity for oxygen continues.   For example, if a contract supplier begins furnishing oxygen equipment to a beneficiary in months 2 through 26, payment would be made for the remaining number of months in the 36-month period, because the number of payments to the contract supplier would be at least 10 payments.  To provide a more specific example, a contract supplier that begins furnishing oxygen equipment beginning with the 20th month of continuous use would receive 17 payments (17 for the remaining number of months  in the 36- month period).  However, if a contract supplier begins furnishing oxygen equipment to a beneficiary in month 27 or later, no more than 10 monthly payments would be made assuming the oxygen equipment remains medically necessary.   Contract supplie r to another contract supplier  This rule does not apply when a beneficiary switches from a contract supplier to another contract supplier to receive his/her oxygen and oxygen equipment. In this scenario, the new contract supplier is paid based on the sing le payment amount for the remaining number of months in the 36-month period assuming the oxygen equipment remains medically necessary.   Grandfathered item where there was a noncontract to contract supplier switch in a prior round   This rule does not apply  to grandfathered items in subsequent competitive bidding rounds when there was a previous noncontract to contract supplier switch in the prior round and the same supplier has elected to continue furnishing the oxygen equipment.  In this case, the grandfat hered supplier would be eligible to continue billing for the remaining number payments left in the oxygen rental period at the start of the competitive bidding round.  The maximum number of monthly rental payments may not exceed 45 rental payments.    40.6 - Payment for Capped Rental DME Items (Rev. 1532, Issued: 06- 11-08, Effective: 07- 01-08, Implementation: 07- 07-08)  The monthly rental payment amounts for capped rental DME (identified using HCPCS modifier RR) are equal to 10 percent of the single payment  amount established for purchase of the item for each of the first 3 months and 7.5 percent of the single payment amount established for purchase of the item for months 4 through 13.   40.6.1 - Change in Suppliers for Capped Rental DME Items (Rev. 1532, Issued: 06 -11-08, Effective: 07- 01-08, Implementation: 07- 07-08)  The following rules apply when the beneficiary switches from one supplier of capped rental DME to another supplier after the beginning of each round of competitive bidding:   Noncontract supplier to contract supplier   In general, rental payments may not exceed a period of continuous use of longer than 13 months.  However, if the beneficiary switches from a noncontract supplier to a contract supplier before the end of the 13- month rental period, a new 13- month period begins and payment is made on the basis of the single payment amounts described in section 40.6. The contract supplier that the beneficiary switches to is responsible for furnishing the item until medical necessity ends, or the 13-month period of continuous use ends, whichever is earlier.  On the first day following the end of the new 13- month rental period, the contract supplier is required to transfer title of the capped rental item to the beneficiary.  Once the beneficiary switches from a noncontract supplier to a contract supplier, they may not switch back to a noncontract supplier if he/she continues to maintain a permanent residence in a CBA.  If, however, the beneficiary relocates out of the CBA to a non- CBA, then he/she may sw itch to a noncontract supplier and a new 13- month rental period does not begin. See section 40.3 for instructions for payment of grandfathered items.  Contract supplier to another contract supplier  If the beneficiary switches from a contract supplier to a  contract supplier before the end of the 13-month rental period, a new 13- month period does not begin.  This provision applies in situations where the beneficiary changes suppliers within a CBA and in situations where the beneficiary relocates and switches  from a contract supplier in one CBA to contract supplier in another CBA.  The contract supplier that the beneficiary switches to is responsible for furnishing the item until medical necessity ends, or the 13 -month period of continuous use ends, whichever is earlier.  On the first day following the end of the 13 -month rental period of continuous use, the contract supplier is required to transfer title of the capped rental item to the beneficiary.   40.7 - Payment for Purchased Equipment  (Rev. 1532, Issued: 06- 11-08, Effective: 07- 01-08, Implementation: 07- 07-08)  The payment amount for the purchase of new equipment (identified using HCPCS modifier NU), including inexpensive or routinely purchased DME, power wheelchairs, and enteral nutrition equipment, is equal to 100 percent of the single payment amounts established for these items.  This payment amount for the purchase of used equipment (identified using HCPCS modifier UE), including inexpensive or routinely purchased DME, power wheelchairs, and enteral nutrition equipment, is equal to 75 percent of the single payment amounts established for new purchase equipment items.  40.8 - Payment for Repair and Replacement of Beneficiary -Owned Equipment  (Rev.  3593, Issued: 08- 17-16, Effective: 10- 01-16, Implementation: 10- 03-16)  Beneficiaries who maintain a permanent residence in a CBA may go to any Medicare- enrolled supplier (contract or noncontract supplier) for the maintenance or repair of beneficiary -owne d equipment, including parts that need to be replaced in order to make the equipment serviceable.  Labor to repair equipment is not subject to competitive bidding and, therefore, will be paid in accordance with Medicares general payment rules.  Payment fo r replacement parts that are part of the competitive bidding program for the area in which the beneficiary resides is based on the single payment amount for that replacement part in the CBA in which the beneficiary lives.  Payment is not made for parts and labor covered under a manufacturers or suppliers warranty.   Beneficiaries must obtain replacements of beneficiary -owned competitively bid items that are part of the competitive bidding program for the areas in which the beneficiary resides from a contract supplier unless the item is a replacement part or accessory that is replaced as part of the service of repairing beneficiary -owned base equipment (e.g., wheelchair, walker, hospital bed, continuous positive pressure airway device, oxygen concentrator, etc.).  All base equipment that is replaced in its entirety because of a change in the beneficiarys medical condition or because the base equipment the beneficiary was using was either lost, stolen, irreparably damaged, or used beyond the equipments reasonable useful lifetime (see section 110.2.C of chapter 15 of the  Benefit Policy Manual) must be obtained from a contract supplier in order to receive Medicare payment.  The contract supplier is not required to replace an entire competitively bid item with the same make and model as the previous item unless a physician or treating practitioner prescribes that make and model.  (See section 30.4 of this chapter.).   If beneficiary -owned oxygen equipment or capped rental DME that is a competitively bid item for the CBA in which the beneficiary maintains a permanent residence  has to be replaced prior to end of its reasonable useful lifetime, then the replacement item must be furnished by the supplier (contract or noncontract supplier) that transferred ownership of the item to the beneficiary.   Payment for replacement of items that are part of the competitive bidding program for the area in which the beneficiary resides is based on the single payment amount for that item.  For additional information regarding payment of a part of a DMEPOS Item, please see Pub.100-04 chapter 20, section 50.5.  40.9 - Payment for Rental Enteral Nutrition Equipment  (Rev. 1532, Issued: 06- 11-08, Effective: 07- 01-08, Implementation: 07- 07-08)  The monthly rental payment amounts for enteral nutrition equipment (identified using HCPCS modifier RR) are e qual to 10 percent of the single payment amount established for purchase of the item for each of the first 3 months and 7.5 percent of the single payment amount established for purchase of the item for months 4 through 15.   40.9.1 - Maintenance and Servici ng of Enteral Nutrition Equipment  (Rev. 1532, Issued: 06- 11-08, Effective: 07- 01-08, Implementation: 07- 07-08)  The contract supplier that furnishes the equipment to the beneficiary in the 15th month of the rental period must continue to furnish, maintain, and service the equipment after the 15 month rental period is completed until a determination is made by the beneficiarys physician or treating practitioner that the equipment is no longer medically necessary.  The payment for maintenance and servicing enteral nutrition equipment is 5 percent of the single payment amount established for purchase of the item .  40.10 - Traveling Beneficiaries  (Rev. 1532, Issued: 06- 11-08, Effective: 07-01-08, Implementation: 07-07-08)  Beneficiaries may travel, for example,  to visit family members or reside in a State with warmer climates during winter months. As a result, beneficiaries will need to consider the following three factors when traveling: (1) where to go to obtain a DMEPOS item; (2) identify whether the item is a competitively bid item or not; and (3) determine the Medicare payment amount for that item. Depending on where the beneficiary travels (whether to a CBA or a non-CBA), the beneficiary may need to obtain DMEPOS from a contract supplier in order for Medica re to cover the item.  For example, a beneficiary who travels to a non -CBA may obtain DMEPOS, if medically necessary, from any Medicare-enrolled supplier. On the other hand, a beneficiary who travels to a CBA should obtain competitively bid items in that C BA from a contract supplier in that CBA in order for Medicare to cover the item. The chart below shows whether a beneficiary should go to a contract supplier or any Medicare- enrolled supplier when the beneficiary travels.   Beneficiary Permanently Resides  Travels to  Type of Supplier  a CBA   a CBA  The beneficiary should obtain competitively bid items in that CBA from a contract supplier located in that CBA if the beneficiary wants Medicare to cover the item.  a non -CBA  Medicare will cover DMEPOS, if medically necessary, from any Medicare -enrolled DMEPOS supplier.  Non-CBA   a CBA  The beneficiary should obtain the competitively bid item from a contract supplier in the CBA if the beneficiary wants Medicare to cover the item.  Non-CBA  Medicare -enrolled DMEPOS supplier   Suppliers that furnish DMEPOS items to Medicare beneficiaries who maintain a permanent residence in a CBA and who travel to a non-CBA need to be aware of the public use files on the CBIC Web site at: http://www.dmecompetitivebid.com/palmetto/cbic.nsf/DocsCat/Home. The public use files contain the ZIP Codes for the CBAs, the HCPCS for competitively bid items, and the single payment amounts for these items. Suppl iers will be able to use these files to identify if the beneficiary traveling to the area maintains a permanent residence in a CBA, determine whether the beneficiary is obtaining a competitively bid item, and determine the single payment amount for those i tems.   The Medicare payment amount is always based on the location in which the beneficiary maintains a permanent residence. For example:   a. If a beneficiary maintains a permanent residence in a CBA and travels outside of the CBA, payment for a competitively  bid item for the CBA in which the beneficiary maintains a permanent residence is the single payment amount for that item in the beneficiarys CBA.