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CPT codes for Home Oxygen Use


Effective October 1, 2012, the following oxygen codes and modifiers will be used to identify home use of oxygen for CH (Cluster Headache), provided pursuant to a Medicare-approved clinical study under Coverage with Evidence Development (CED) 

HCPCS Codes

E0424 Stationary Compressed Gaseous Oxygen System, Rental; Includes Container, Contents, Regulator, Flowmeter, Humidifier, Nebulizer, Cannula or Mask, and Tubing

E0441 Stationary Oxygen Contents, Gaseous, 1 Month’s Supply = 1 Unit

E0443 Portable Oxygen Contents, Gaseous, 1 Month’s Supply = 1 Unit

Modifiers

QF Prescribed Amount of Oxygen Exceeds 4 Liters Per minute (LPM) and Portable Oxygen is Prescribed

QG Prescribed Amount of Oxygen is Greater than 4 Liters Per Minute (LPM).

Payment for Oxygen Contents 

Beginning with dates of service on or after the end date of service for the month representing the 36 th  payment for code E0424, suppliers may bill on a monthly basis for furnishing oxygen contents (stationary and/or portable). If only stationary gaseous oxygen equipment was furnished in month 36 and billed with code E0424, suppliers may bill on a monthly basis for stationary oxygen contents using HCPCS code E0441.  However, if both gaseous stationary and portable oxygen equipment were furnished in month 36 and billed using code E0424 “QF”, suppliers may bill on a monthly basis for both stationary and portable oxygen contents using HCPCS codes E0441 and E0443.  

Additional Billing Information

Specifically, DME MACs will pay claims with dates of service on or after October 1, 2012, for home use of oxygen for the treatment of Cluster Headaches (CH) during the 36 month rental period, if they contain all of the following:

•  HCPCS code E0424; and Modifier “QF” or “QG” and modifier Q0 (clinical trial); and

•  ICD-9 diagnosis code 339.00, 339.01, or 339.02; and

•  ICD-9 diagnosis code V70.7; and

•  POS 12 (home)

Adding the 8-digit clinical trial number is optional.

DME MACs will pay claims with dates of service on or after October 1, 2012, for home use of oxygen for the treatment of Cluster Headaches (CH) after the 36 month rental period, if they contain all of the following

•  HCPCS code E0441 and/or E0443; and 

•  Modifier modifier Q0 (clinical trial); and

•  ICD-9 diagnosis code 339.00, 339.01, or 339.02; and

•  ICD-9 diagnosis code V70.7; and

•  POS 12 (home).

Again, adding the 8-digit clinical trial number is optional.

Effective October 1, 2012, DME MACs will deny claims received with HCPCS code E1399 when billed with ICD-9 diagnosis code(s) 339.00, 339.01, or 339.02.

For more information please refer

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7820.pdf

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