Guide to Prescribing Home Oxygen Costs

Guide to Prescribing Home Oxygen

by Thomas
L. Petty, M.D.


The Key
to Prescibing Home Oxygen


to Successful Treatment

Oxygen Options

Device Technology

and Reimbursement

Considerations in Selecting Equipment

Thomas L. Petty, M. D.

For educational
purposes only.

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.