Continuation of Maintenance and Servicing Payments in CY 2010 for Certain Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008
MLN Matters® Number: MM6716
Related Change Request (CR) #: 6716
Related CR Release Date: November 2, 2009
Effective Date: January 1, 2010
Related CR Transmittal #: R589OTN
Implementation Date: January 4, 2010
Provider Types Affected
This article is for suppliers submitting claims to Medicare contractors (Regional Home Health Intermediaries (RHHIs), Medicare Administrative Contractors (MACs) and/or Durable Medical Equipment Medicare Administrative Contractors (DME MACs)) for oxygen services provided to Medicare beneficiaries.
Provider Action Needed
This article is based on change request (CR) 6716, which provides instructions on continuing the payment policy for general maintenance and servicing of certain oxygen equipment after the 36-month rental cap, as established in calendar year (CY) 2009, for dates of service through June 30, 2010. See the Key Points section of this article for specific payment instructions.
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 rental cap. Section 144(b)(1) of the MIPPA, provides for payment for reasonable and necessary maintenance and servicing of oxygen equipment furnished after the 36-month rental cap if the secretary of the Department of Health and Human Services determines that such payments are reasonable and necessary. Initial instructions relating to the maintenance and servicing payments for oxygen concentrators and transfilling equipment for CY 2009 were issued in Transmittal 497, CR 6509, dated May 22, 2009. The MLN Matters® article for this CR is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6509.pdf on the Centers for Medicare & Medicaid Services (CMS) website. CR6716 provides instructions on the continuation of these maintenance and servicing payments in CY 2010 for dates of service through June 30, 2010.
As indicated in Transmittal 497 (CR 6509), CMS 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 Healthcare Common Procedure Coding System (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 no more often than every 6 months, beginning 6 months after the 36-month rental cap (as early as July 1, 2009, in some cases). In CY 2009, the allowed payment amount for each visit is equal to the 2009 fee for HCPCS code K0739, multiplied by 2, 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 E1392 MS 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 aintenance and servicing for a stationary concentrator (HCPCS code E1390 or E1391) and a transfilling unit (HCPCS code K0738), payment can be made for maintenance and servicing of both units (HCPCS code/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 (HCPCS code/modifier E1392MS).
For example, if maintenance and servicing is billed for a column I code, additional payment for the maintenance and servicing of any of the column II codes will not be made.
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Column I HCPCS Code/Modifier
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Column II HCPCS Code/Modifier
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E1390 MS
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E1391 MS, E1392 MS
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E1391 MS
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E1390 MS, E1392 MS
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E1392 MS
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E1390 MS, E1391 MS, K0738 MS
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K0738 MS
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E1392 MS
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For CY 2010, CMS has determined that it is reasonable and necessary to continue the existing payments and payment methodology, as described above and in Transmittal 497 (CR 6509), for maintenance and servicing of certain oxygen equipment for dates of service through June 30, 2010. For dates of service from January 1, 2010 through June 30, 2010, the allowed payment amount for each visit is equal to 2 units of the 2010 fee for HCPCS code K0739, for the State in which the in-home visit takes place.
Key Points of CR 6716
- Medicare contractors will pay claims with dates of service from July 1, 2009 thru June 30, 2010, for maintenance and servicing for oxygen concentrators no more often than every 6 months beginning 6 months after the end of the 36th month of continuous use when billed with one of the following HCPCS codes and modifiers:
- E1390MS;
- E1391MS; or
- E1392MS.
- In addition to payment for maintenance and servicing for stationary oxygen concentrators (HCPCS codes E1390 or E1391 Medicare contractors will pay claims with dates of service from July 1, 2009 through June 30, 2010, for maintenance and servicing for portable oxygen transfilling equipment (HCPCS code K0738) no more often than every 6 months beginning 6 months after the end of the 36th month of continuous use when billed with the HCPCS modifier MS.
- Medicare contractors will not pay for maintenance and servicing of both a portable oxygen concentrator (E1392MS) and portable oxygen transfilling equipment (K0738MS).
- For the oxygen equipment HCPCS codes E1390, E1391, E1392, and K0738, billed with the HCPCS modifier MS, Medicare contractors will make maintenance and servicing payments for covered services equal to the lesser of the supplier’s actual charge or 2 units of HCPCS code K0739 every 6 months.
- Medicare contractors will deny claims for maintenance and servicing of oxygen equipment when billed with the HCPCS codes E0424, E0439, E0431, E0434, E1405 or E1406 and the MS HCPCS modifier.
Additional Information
If you have questions, please contact the Palmetto GBA Provider Contact Center at our toll-free number, (866) 801-5301.
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. CPT only copyright 2009 American Medical Association.