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Answering the Q Modifier Question

Posted on in Billing/Reimbursement

In April 2018, Medicare added what we call the “Q” modifiers to oxygen equipment: see Oxygen CMN update.pdf. These are pricing modifiers that need to be considered for an oxygen claim that is based on a high liter, low liter flow, or when the liter flow rates differ between at rest and nighttime use, and if portable is included.   

Knowing the right (if any) Q modifier for claim processing can be confusing.  To help members, the team at VGM Respiratory developed a tool that provides guidance as to which Q modifier to append to a claim, called the “O2 Q Chart."

There was also a revision in the article regarding the CMN and how to answer question 5 in section B.  The physician will answer the question as it is asked “Enter the highest oxygen flow rate ordered for this patient in liters per minute. If less than 1 LPM, enter an “X”." This means they enter the highest liter flow ordered regardless if it is at rest, at night, or with activity. 

Here are two scenarios:

1. Stationary equipment ordered:  Patient prescribed O2 @ 5 lpm at night only

Average = 5lpm + 0 lpm daytime = 5/2 =2.5lpm (use rounding rules) = 3lpm

MD should be reporting 5LPM in question 5 

Answer = No Q modifiers needed

2. Stationary equipment & portable equipment ordered

Patient prescribed O2 @ 5lpm at rest, 6lpm with activity, and 5lpm with sleep

Daytime and Night time use the same liter flow

MD reports 6lpm on CMN question #5

Answer =Q modifier needed; QF

Members can login to utilize this new tool here. For more information on becoming a VGM member, contact us!