Physicians! Are You Ordering Oxygen for Your Patient?

When ordering oxygen therapy for your patients that are Medicare beneficiaries, please remember that you must see the beneficiary within 30 days prior to the start of oxygen therapy to discuss the condition necessitating the home use of oxygen. Your patient must meet coverage indications and a qualifying test as outlined in the DME MAC Oxygen and Oxygen Equipment Local Coverage Determination (LCD).

Your medical record documentation must also show that other alternative treatments (e.g., medical and physical therapy directed at secretions, bronchospasm and infection) have been tried or considered and deemed clinically ineffective. The medical record and prescription should indicate the oxygen flow rate (e.g., 2 liters per minute), the estimation of the frequency (e.g., 30 minutes per hour), duration of use (e.g., 12 hours per day) and duration of need (e.g., 12 months).

You must specify the type of oxygen delivery system to be used (e.g., a portable as well as a stationary concentrator or a compressed gas portable system along with a stationary concentrator). If a portable system is ordered, there are special requirements that must be included in the medical record, including that the patient is mobile within the home and that the qualifying blood gas study was performed either at rest or while exercising, but not while asleep.

In addition, for scenarios where the beneficiary has different daytime and nighttime oxygen flow requirements, you must document these values in your patient’s medical record. This information is used by the DME supplier to determine billing information for Medicare.

Medicare can make payment for home oxygen supplies and equipment when the patient's medical record shows that the patient has significant hypoxemia from a medical condition and meets medical documentation, test results, and health conditions as specified in the National Coverage Determination (NCD) Manual, CMS Internet-Only Manual (IOM) Publication 100-03, Section 240.2 (PDF, 1.02 MB).

Please complete and sign Form CMS-484 (Certificate of Medical Necessity (CMN): Oxygen) (PDF, 208 KB) in a timely manner. However, the CMN itself is not considered part of the medical record. All information included on the CMN must be supported by the contemporaneous medical record. You can find instructions on completing this form in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 5 (PDF, 196 KB).

The Comprehensive Error Rate Testing (CERT) contractor has identified multiple errors in claims received for oxygen equipment and supplies.  These errors include no documentation of an encounter prior to the oxygen order, no documentation of oxygen orders prior to delivery, no indication of the qualifying test results in the medical record as reported on the CMN and no documentation to support continued need for home oxygen therapy.

Help your patients, the DME suppliers and the Medicare program by verifying you have the medical documentation to support the oxygen orders and CMNs for your patients.  This allows Medicare to pay claims appropriately and efficiently.

Please visit the DME MAC contractor websites for additional information and resources on Medicare’s coverage of oxygen and oxygen equipment.

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