CMS Pub. 100-04, ch. 20, § 130.6

The following instructions apply to all claims from providers and suppliers to whom

payment may be made for oxygen. The chart in §130.6.1 indicates what is payable under

which situation.

A. Monthly Billing

Fee schedule payments for stationary oxygen system rentals are all inclusive and

represent a monthly allowance per beneficiary. Accordingly, a supplier must bill on a

monthly basis for stationary oxygen equipment and contents furnished during a rental

month.

A portable equipment add-on is also payable when portable oxygen is prescribed and it is

determined to be medically necessary in accordance with Medicare coverage

requirements. The portable add-on must be claimed in order to be paid. (See §30.6.)

B. HCPCS Codes

The HCPCS codes must be used to report the service. One month of service equals one

unit.

C. Use of Payment Modifiers and Revenue Codes for Payment Adjustments

The monthly payment amount for stationary oxygen is subject to adjustment depending

on the amount of oxygen prescribed (liters per minute (LPM)), and whether or not

portable oxygen is also prescribed. (See §30.6.) HHAs billing the A/B MAC (HHH) for

stationary equipment, supplies, or contents, which are not eligible for payment

adjustment, bill under revenue code 0601. Claims must indicate the appropriate HCPCS

modifier described below, if applicable.

• If the prescribed amount of oxygen is less than 1 LPM, suppliers use the

modifier "QE"; HHAs use revenue code 0602. The monthly payment amount

for stationary oxygen is reduced by 50 percent.

• If the prescribed amount of oxygen is greater than 4 LPM, suppliers use the

modifier "QG"; HHAs use revenue code 0603. The monthly payment amount

for stationary oxygen is increased by 50 percent.

• If the prescribed amount of oxygen exceeds 4 LPM and portable oxygen is

prescribed, suppliers use the modifier "QF"; HHAs use revenue code 0604. The

monthly payment for stationary oxygen is increased by the higher of 50 percent

of the monthly stationary oxygen payment amount, or, the fee schedule amount

for the portable oxygen add-on. (A separate monthly payment is not allowed

for the portable equipment.) Effective April 1, 2017, the modifier “QF” must be

used with both the stationary and portable oxygen equipment codes.

Effective April 1, 2017, portable oxygen “QF” modifier fee schedule amounts will be

added to the DMEPOS fee schedule file. The portable oxygen “QF” fee schedule

amounts will represent the higher of 1) 50 percent of the monthly stationary oxygen

payment amount or 2) the fee schedule amount for the portable oxygen add-on.

There are three claims processing scenarios:

Scenario 1 – A claim for stationary oxygen equipment is submitted with the QG modifier.

The history is reviewed and it is discovered that portable oxygen equipment was billed

AND paid within the last 30 days prior to the stationary oxygen equipment’s date of

service. Since we have already paid the portable add-on, we can’t pay the volume

adjustment add-on, therefore billing with QG modifier is inappropriate and the claim

should be returned as unprocessable.

Scenario 2 – A claim for stationary oxygen equipment is submitted with the QG modifier

and within 30 days, a claim for portable oxygen equipment is received. In this case we

have already paid the volume add-on so the portable equipment add –on is returned as

unprocessable.

Scenario 3 – A claim for stationary oxygen equipment is submitted with the QG modifier

AND the portable oxygen equipment comes in with the same date of service. In this case

EVERYTHING is returned as unprocessable due to the incorrect use of the modifier and

neither is valid.

NOTE: All these claims are being returned as unprocessable since there is no way for

Medicare to know whether the first claim submitted was billed incorrectly or if the

subsequent claim was billed incorrectly.

Contractors shall use the following messages for claims that are returned as

unprocessable:

Group Code: CO (Contractual Obligation)

CARC 4 - The procedure code is inconsistent with the modifier used or a required

modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment

(loop 2110 Service Payment Information REF), if present.

RARC MA130 - Your claim contains incomplete and/or invalid information, and no

appeal rights are afforded because the claim is unprocessable. Please submit a new claim

with the complete/correct information.

The following three new pricing modifiers are added to the HCPCS file effective April 1,

2018:

QA PRESCRIBED AMOUNTS OF STATIONARY OXYGEN FOR DAYTIME

USE WHILE AT REST AND NIGHTTIME USE DIFFER AND THE

AVERAGE OF THE TWO AMOUNTS IS LESS THAN 1 LITER PER

MINUTE (LPM)

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

(LPM) AND PORTABLE OXYGEN IS PRESCRIBED

QR PRESCRIBED AMOUNTS OF STATIONARY OXYGEN FOR DAYTIME

USE WHILE AT REST AND NIGHTTIME USE DIFFER AND THE

AVERAGE OF THE TWO AMOUNTS IS GREATER THAN 4 LITERS PER

MINUTE (LPM)

Additionally, the existing QE, QF, and QG modifiers are revised to clarify that the

prescribed flow rate at rest is used in accordance with regulations at 42 CFR

414.226(e)(3). This section instructs that if the prescribed flow rate is different for the

patient at rest than for the patient at exercise, the flow rate for the patient at rest is used.

Effective April 1, 2018, the modifiers are revised to read:

QE PRESCRIBED AMOUNT OF STATIONARY OXYGEN WHILE AT REST

IS LESS THAN 1 LITER PER MINUTE (LPM)

QF PRESCRIBED AMOUNT OF STATIONARY OXYGEN WHILE AT REST

EXCEEDS 4 LITERS PER MINUTE (LPM) AND PORTABLE OXYGEN IS

PRESCRIBED

QG PRESCRIBED AMOUNT OF STATIONARY OXYGEN WHILE AT REST

IS GREATER THAN 4 LITERS PER MINUTE (LPM)

Beginning April 1, 2018, claims for monthly oxygen volume adjustments must indicate

the appropriate HCPCS modifier described below as applicable. Oxygen fee schedule

amounts are adjusted as follows:

If the prescribed amount of oxygen is less than 1 LPM, suppliers use either of the

following modifiers with the stationary oxygen HCPCS code:

• The modifier “QE” PRESCRIBED AMOUNT OF STATIONARY OXYGEN

WHILE AT REST IS LESS THAN 1 LITER PER MINUTE (LPM); HHAs use

revenue code 0602. The monthly payment amount for stationary oxygen is

reduced by 50 percent.

• The modifier “QA” PRESCRIBED AMOUNTS OF STATIONARY OXYGEN

FOR DAYTIME USE WHILE AT REST AND NIGHTIME USE DIFFER AND

THE AVERAGE OF THE TWO AMOUNTS IS LESS THAN 1 LITER PER

MINUTE (LPM); The monthly payment amount for stationary oxygen is reduced

by 50 percent. This modifier is used when the prescribed flow rate is different for

nighttime use and daytime use and the average of the two flow rates is used in

determining the volume adjustment.

If the prescribed amount of oxygen is greater than 4 LPM, suppliers use either of the

following modifiers with the stationary oxygen HCPCS code:

• The modifier “QG” PRESCRIBED AMOUNT OF STATIONARY OXYGEN

WHILE AT REST IS GREATER THAN 4 LITERS PER MINUTE (LPM);

HHAs use revenue code 0603. The monthly payment amount for stationary

oxygen is increased by 50 percent.

• The modifier “QR” PRESCRIBED AMOUNTS OF STATIONARY OXYGEN

FOR DAYTIME USE WHILE AT REST AND NIGHTIME USE DIFFER AND

THE AVERAGE OF THE TWO AMOUNTS IS GREATER THAN 4 LITERS

PER MINUTE (LPM); HHAs use revenue code 0603. The monthly payment

amount for stationary oxygen is increased by 50 percent.

If the prescribed amount of oxygen is greater than 4 LPM and portable oxygen is

prescribed, suppliers use either of the following modifiers with both the stationary and

portable oxygen HCPCS code:

• The modifier “QF” PRESCRIBED AMOUNT OF STATIONAY OXYGEN

WHILE AT REST EXCEEDS 4 LITERS PER MINUTE (LPM) AND

PORTABLE OXYGEN IS PRESCRIBED; HHAs use revenue code 0604. If the

prescribed flow rate differs between stationary and portable oxygen equipment,

the flow rate for the stationary equipment is used. The monthly payment for

stationary oxygen is increased by the higher of 50 percent of the monthly

stationary oxygen payment amount, or the fee schedule amount for the portable

oxygen add-on. A separate monthly payment is not allowed for the portable

equipment. Effective April 1, 2017, the modifier “QF” must be used with both the

stationary and portable oxygen equipment codes.

• The modifier “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 (LPM) AND PORTABLE OXYGEN IS PRESCRIBED; HHAs use

revenue code 0604. If the prescribed flow rate differs between stationary and

portable oxygen equipment, the flow rate for the stationary equipment is used.

The monthly payment for stationary oxygen is increased by the higher of 50

percent of the monthly stationary payment amount, or the fee schedule amount for

the portable oxygen add-on. A separate monthly payment is not allowed for the

portable equipment. Effective April 1, 2018, the modifier “Q??” must be used

with both the stationary and portable oxygen equipment codes. The stationary and

portable oxygen equipment QB fee schedule amounts will be added to the

DMEPOS fee schedule file effective 4/1/2018.

The stationary oxygen QF and QB fee schedule amounts on the DMEPOS fee schedule

file represent 100 percent of the stationary oxygen allowed fee schedule amount. The

portable oxygen equipment add-on QF and QB fee schedule amount on the file by state

represent the higher of:

1. 50 percent of the monthly stationary oxygen payment amount (codes E0424,

E0439, E1390 or E1391); or

2. The fee schedule amount for the portable oxygen add-on (codes E0431, E0433,

E0434, E1392 or K0738).

D. Conserving Device Modifier

The HHA's and suppliers must indicate if an oxygen conserving device is being used with

an oxygen delivery system by using HCPCS modifier “QH”.

E. DME MACs Only

For all States that have licensure/certification requirements for the provision of oxygen

and/or oxygen related products, DME MACs shall process claims for oxygen and oxygen

related products only when an oxygen specialty code is assigned to the DMEPOS

supplier by the NSC and is forwarded to the DME MACs from the NSC.

This specialty shall be licensed and/or certified by the State when applicable. This

specialty shall bill for Medicare-covered services and/or products when State law permits

such entity to furnish oxygen and/or oxygen related products.