Payment for Repair, Maintenance and Servicing of Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008

Provider Types Affected
Providers and suppliers submitting claims to Medicare DME Medicare Administrative Contractors (DME MACs), and/or Regional Home Health Intermediaries (RHHIs) for repair, maintenance and servicing of oxygen equipment provided to Medicare beneficiaries.

Provider Action Needed
This article is based on Change Request (CR) 6296 and alerts providers that the Centers for Medicare & Medicaid Services (CMS) is providing instructions regarding repair, maintenance, and servicing of oxygen equipment resulting from implementation of Section 144(b) of the MIPPA. The 36-month cap noted in MIPPA applies to stationary and portable oxygen equipment furnished on or after January 1, 2006. Therefore, the 36-month cap may end as early as January 1, 2009, for beneficiaries using oxygen equipment on a continuous basis since January 1, 2006.

CMS has determined that, for services furnished during calendar year 2009, it is reasonable and necessary to make payment for periodic, in-home visits by suppliers to inspect certain oxygen equipment and provide general maintenance and servicing after the 36-month rental cap. These payments only apply to equipment falling under HCPCS codes E1390, E1391, E1392 and K0738, and only when the supplier physically makes an in-home visit to inspect the equipment and provide any necessary maintenance and servicing. Payment may be made every 6 months, beginning 6 months after the 36-month rental cap (as early as July 1, 2009, in some cases), and the allowed payment amount for each visit is equal to the 2009 fee for HCPCS code E1340 (HCPCS code K0739 for dates of service on or after April 1, 2009) multiplied by two, for the state in which the in-home visit takes place.

Suppliers should use the HCPCS code for the equipment E1390, E1391, E1392 and/or K0738 along with the MS HCPCS modifier in order to bill and receive payment for these maintenance and servicing visits. For example, if the supplier visits a beneficiary’s home in Pennsylvania to perform the general maintenance and servicing on a portable concentrator, the supplier would enter HCPCS code/modifier E1392MS on the claim and the allowed payment amount would be equal to the lesser of the supplier’s actual charge or two units of the allowed payment amount for HCPCS code K0739 in Pennsylvania. If the supplier visits the beneficiary’s home to provide the periodic maintenance and servicing for a stationary concentrator (HCPCS codes E1390 or E1391) and a transfilling unit (HCPCS code K0738), payment can be made for maintenance and servicing of both units (HCPCS codes/HCPCS modifier E1390MS or E1391MS and K0738MS). If the supplier visits the beneficiary’s home to provide the periodic maintenance and servicing for a portable concentrator (HCPCS code E1392), payment can only be made for maintenance and servicing of the one unit/HCPCS code/modifier (E1392MS).

Background
Section 144(b) of MIPPA repeals the transfer of ownership provision established by the Deficit Reduction Act (DRA) of 2005 for oxygen equipment and establishes new payment rules and supplier responsibilities after the 36-month payment cap. Initial instructions related to implementation of these changes were issued as part of the January 2009 Durable Medical Equipment Prosthetics Orthotics & Supplies (DMEPOS) Fee Schedule Update, CR 6297. The MLN Matters article related to CR 6297 may be viewed at www.cms.hhs.gov/MLNMattersArticles/downloads/mm6297.pdf (PDF, 136 KB) on the CMS Web site.

• To distinguish between the repair or nonroutine service of beneficiary-owned DME and oxygen equipment, two new ‘K’ HCPCS codes are effective for claims with dates of service on or after April 1, 2009. Those ‘K’ HCPCS codes are:
  • K0739 - Repair or Nonroutine Service for Durable Medical Equipment Other than Oxygen Equipment Requiring the Skill of a Technician, Labor Component, Per 15 Minutes
  • K0740 - Repair or Nonroutine Service for Oxygen Equipment Requiring the Skill of a Technician, Labor Component, Per 15 Minutes
• The new non-covered HCPCS code K0740 should be used by suppliers to indicate the labor associated with the repair of stationary or portable oxygen equipment.
• The existing E1340 HCPCS code is invalid for Medicare claims, effective April 1, 2009. The revised 2009 labor payment rates, provided in CR 6297, map directly to the new HCPCS code K0739 code and will be used to pay claims for HCPCS code K0739 with dates of service on or after April 1, 2009.
• Note that the two new codes are not yet final and should not be used until effective on April 1, 2009.
• DME MACs and RHHIs:
  • Deny claims with dates of service on or after April 1, 2009 for HCPCS code K0740
  • Will deny claims with dates of service on or after January 1, 2009, for claims received on or after April 6, 2009, for replacement parts billed using a HCPCS code and the ‘RB’ HCPCS modifier when the part is replaced in conjunction with the repair of oxygen equipment identified by HCPCS codes E0424, E0431, E0434, E0439, E1390, E1391, E1392, E1405, E1406 or K0738

Additional Information
For complete details regarding this CR please see the official instruction (CR 6296) issued to your Medicare DME MAC, or RHHI. That instruction may be viewed by going to www.cms.hhs.gov/Transmittals/downloads/R443OTN.pdf (PDF, 137 KB)on the CMS Web site.

If you have any questions, please contact our Provider Contact Center at our toll-free number, (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B). 

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

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