With their April 1st update, the Centers for Medicare and Medicaid Services (CMS) released changes for several sets of codes, including those used to report durable medical equipment (DME). DME includes everything from prosthetics to orthotics to miscellaneous supplies such as portable oxygen tanks, but most of this update focused on the latter.
The biggest change in the update was the revision of DME modifiers, including the modifier QF (Prescribed amount of oxygen is greater than 4 liters per minute and portable oxygen is prescribed). When this code is used, Medicare will reimburse either 50% of the stationary oxygen payment amount (for codes E0424, E0439, E1390, and E1391) or the portable oxygen add-on amount (for codes E0431, E0433, E0434, E1392, and K0738). It is important to note that CMS will pay for the higher of these two, but not both.
Another DME modifier that saw changes was QB (Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute and portable oxygen is prescribed). Proper reimbursement for claims using QB involves meeting several requirements: the oxygen must be prescribed, the average amount used must be higher than four liters per minute, and the flow rates for daytime and nighttime must be different. As with modifier QF, claims that use QB are reimbursed as either 50% of the stationary payment amount or all of the portable add-on amount, but not both.
If you work for a practice that prescribes oxygen or other DME, be sure to review these April updates and stay tuned for any more that may occur in the future. CMS makes updates every quarter, so be on the lookout for the next set of coding and reimbursement changes at the beginning of July.