Changes with DME

June 20th, 2017 - Chris Woolstenhulme, CPC, CMRS
Categories:   HCPCS Coding  
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Due to the cost and refills that is required with portable oxygen systems separate payment classes were added in 2007 for oxygen generating portable equipment. Each year, Payment Classes for Oxygen Generating Portable Equipment, Stationary Oxygen Contents, and Portable Oxygen Contents, are adjusted to make additional payment classes for oxygen and oxygen equipment.

 E0424, E0439, E1390, and E1391, E0433 and K0738, E0441 and E0442, E0443 and E0444

Tuesday, December 13, 2016, the 21st Century Cures Act (the Cures Act) was enacted into law. Section 16007(a). This was the beginning of the 6 month phase in period. During the phase in period, the fee schedules are paid based on 50% of the unadjusted and adjusted amounts of fee schedules from July 1, 2016 through Dec 31, 2016.

Note: the fully adjusted DMEPOS Fee Schedule files that were in effect July 1, 2016 through December 31, 2016 are available on the DMEPOS Fee Adjustment Monitoring webpage.

Separate payment classes for oxygen and oxygen equipment

Each year, the fee schedule amounts for stationary oxygen equipment are adjusted as there are separate payment classes for oxygen and oxygen equipment. For more details on methodology, rule-making, and the percentage of reductions is available for download and was published in the Federal Register on November 9, 2006 (71 FR 65884).

Ruling on January 12, 2017 concluded that certain continuous glucose monitors (CGMs), are referred to as therapeutic CGMs.

E1399 – NU, RR and UE Modifiers

Who should you contact to determine which HCPCS code to use for billing?

PDAC Helpline:  877-735-1326

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