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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/17/13

Oxygen Policy Clarification for Residents of Long Term Care Facilities

To:​ Enrolled Durable Medical Equipment and Supplies (DME) Providers; Pharmacies; Long Term Care Facilities; and Supportive Living Facilities​
Date:​ October 17, 2013​
Re:​ Oxygen Policy Clarification for Residents of Long Term Care Facilities​

In an informational notice dated September 27, 2012, HFS identified oxygen reimbursement changes effective December 1, 2012. This notice clarifies oxygen prior approval and billing requirements for residents of long term care facilities (LTCFs), excluding supportive living facilities (SLFs).

Long term care facilities that are enrolled to supply oxygen for its residents are not required to obtain prior approval. DME companies that dispense oxygen to patients in LTCFs must follow the prior approval submission requirements.

For patients in LTCFs, the facility is required to provide the first tank for each resident each month. The first tank cannot be billed to HFS. The first tank is defined as the following:

  • One "H" tank (6900 liters) or

  • Two "E" tanks (623 liters) or

  • 20 pounds of liquid oxygen

If an oxygen concentrator, HCPCS code E1390, is dispensed, no other method of oxygen administration is reimbursable.

HFS allows only one stationary content code and one portable content code to be billed when a resident is on oxygen more than two hours per day after the LTCF has fulfilled its supply requirement. The following codes are open for LTCFs:

  • E0441 – stationary oxygen contents, gaseous

  • E0442 – stationary oxygen contents, liquid (recently opened retroactive to dates of service beginning December 1, 2012)

  • E0443 – portable oxygen contents, gaseous

  • E0444 – portable oxygen contents, liquid

The above codes include only content and not the administration supplies, which are the responsibility of the facility as part of the per diem rate. All fee schedule updates are announced via an e-mail notification, and are posted on the DME Fee Schedule. Providers may sign up to register for e-mail notification of new information published on the department's website.

Any questions regarding this notice may be directed to a DME billing consultant in the Bureau of Comprehensive Health Services at 877-782-5565, option 3, option 2.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs