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Are You Content with Your O2 CONTENT?

Posted on in Billing/Reimbursement

By Ronda Buhrmester, Reimbursement Specialist

Oxygen suppliers, are you getting your money’s worth during months 37-60? We are all well aware that once month 37 arrives, the regular monthly rental for oxygen ends. This is not the end of reimbursement during, what I call, the 24-month black hole. Do you know if your company is capturing the reimbursement during that timeframe? 

There are additional opportunities to capture the payment for oxygen equipment with portable oxygen content and maintenance/servicing. In this article, the discussion will be about oxygen content. 

Who’s Responsible?

Let’s start with who is responsible for the oxygen equipment during the black hole. The supplier who provided the equipment during month 36 and was paid for month 36 is required to continue to provide equipment, accessories, maintenance, and repair until the end of the five-year reasonable useful lifetime (RUL). This basically means the supplier is “married” to the patient until the RUL is reached. 

If the patient was using a portable unit during the initial 36 months, the portable oxygen content is reimbursable as long as the patient needs the content (tanks). One unit is equal to one month; it’s a flat fee with an allowable that averages around $40-50, depending on your location. It’s not a per delivery charge or a per tank charge. The one unit covers the entire content amount for that month starting with the day after the anniversary date of the oxygen equipment. A maximum of three months can be billed at one time, but the patient must need/use the content all three months.

For example, if oxygen equipment begins June 11 and ends July 10, begin monthly oxygen portable content on or after July 11 (after 36-month cap).

If the patient began using portable equipment after starting on stationary equipment, payment for the portable would continue until the end of the 36-month rental period for that portable equipment even though payment could also be made for the contents. The supplier will receive payment for both the portable and content at the same time with this scenario (during months 37-60). Both HCPCS codes need to be submitted in order to receive payment for the “base” (portable unit) and the content.

Part of the F2F Ruling

Portable content is part of the face-to-face ruling under the ACA 6407, which means the detailed description of the content must be on your DWO prior to delivery. Make sure the order and CMN have a detailed description such as “portable gaseous content,” “portable liquid content,” etc. Be detailed so the word “gaseous” or “liquid” is included to match the description of the HCPCS code.

If the portable content description is added to the initial order (at initial setup), there is no need for a new order at month 37. If the description is not on the initial order, the patient needs a new face-to-face evaluation and a new DWO; both have to be obtained prior to delivery (remember the DWO has to be within six months of the visit). The supplier needs to make sure to have proof of delivery on file to prove the patient actually received the content.

The chart below is a good reference for capturing portable content reimbursement. Not all oxygen equipment has reimbursement available for portable oxygen content: 

Equipment Furnished in Month 36  Monthly Contents After Capped Rental
 O2 Concentrator Only (E1390, E1391, or E1392)  None
 Portable Gas Transfill (K0738)  None
 Portable Liquid Transfill (E1399)  None
 Stationary Gas O2 System (E0424)  Yes - Gas Contents (E0441)
 Stationary Liquid O2 System (E0439)  Yes - Liquid Contents (E0442)
 Portable Gas System (E0431)  Yes - Portable Gas Contents (E0443)
 Portable Liquid System (E0434)  Yes - Portable Liquid Contents (E0444)

Conclusion

Are you capturing the portable content during months 37-60? If you are unsure, then run a report in your billing software to identify those patients who have portable systems. Then, you can check for the portable content HCPCS codes that should be getting submitted for payment and reimbursed during the black hole of months 37-60.

As always, please contact me with any questions.

Ronda Buhrmester, CRT, CFm
ronda.buhrmester@vgm.com
Cell: 217-855-5440 (call or text)
Office: 888-665-6518