NLHEP
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Guide to Prescribing Home Oxygen
by Thomas L. Petty, M.D.
Contents
The Key to Prescibing Home Oxygen
Costs and Reimbursement
Patient Considerations in Selecting Equipment
Costs and Reimbursement
For your Medicare patients with Part B coverage, claims for oxygen are submitted by the supplier to one of four Durable Medical Equipment Regional Carriers (DMERC) depending upon the region of the country in which you live. You must complete and sign a Certificate of Medical Necessity, DMERC Form 484.2, which describes the patient's need for oxygen, including blood gas levels or arterial oxygen saturation levels, prescribed flow rate and medical condition.
On assigned claims, Medicare reimburses the supplier at a fixed rate for stationary oxygen systems, from $194 to $228 per month in 1999, depending on the carrier. Portable oxygen may be covered at an additional $18 to $21 per month (depending on the carrier) if the requirements for medical necessity for portable oxygen are documented on the Certificate of Medical Necessity (CMN). Medicare Part B provides these benefits at 80% of the allowable charges. The patient, or his or her secondary insurance, is responsible for the remaining 20%. Medicare's coverage policies do vary slightly from region to region. Check with your Durable Medical Equipment Regional Carrier (DMERC) for the initial and ongoing documentation requirements specific to your region.
Medicare's coverage policy for oxygen is "modality neutral." Their coverage policy is the same whether oxygen is supplied by compressed gas, a concentrator or a liquid system. Often, suppliers profit more from patients placed on concentrators than on those using liquid or compressed gas systems. You may find that many suppliers have begun to encourage the use of a concentrator, supplemented by an E cylinder when portable oxygen is required. Your prescriptions for portable oxygen, based upon the ambulatory requirements and any financial constraints of your patients, must be filled as written. A supplier cannot change a physician's prescription. If you believe a specific modality of stationary or portable oxygen will best accommodate your patient's ability to participate in a full range of physical activity, it should be specified on the CMN. In light of the current oxygen reimbursement environment, it may be necessary for you to work closely with your local suppliers in order to ensure that your patients' oxygen requirements and daily living requirements are met to everyone's satisfaction, to provide the highest possible quality of life for your patients.