US · guidance
CMS Pub. 100-04, ch. 20, § 30.6.4
DMEPOS Clinical Trials and Demonstrations
The definition of the QR modifier is “item or service has been provided in a Medicare
specified study.” When this modifier is attached to a HCPCS code, it generally means
the service is part of a CMS related clinical trial, demonstration or study.
• The DME MACs shall recognize the “QR” modifier when associated with an
oxygen home therapy clinical trial identified by CMS and sponsored by the National
Heart, Lung & Blood Institute. DME MACs shall pay these claims if the patient’s
arterial oxygen partial measurements are from 56 to 65 mmHg, or whose oxygen
saturation is at or above 89%.
The definition of condition code 30 is “qualified clinical trial.” When this condition code
is reported on a claim, it generally means the service is part of a CMS related clinical
trial, demonstration or study.
The A/B MACs (HHH) shall recognize condition code 30, accompanied by ICD-9-CM
diagnosis code V70.7 or ICD-10 diagnosis code Z00.6, as applicable, in the second
diagnosis code position, when associated with an oxygen home therapy clinical trial
identified by CMS and sponsored by the National Heart, Lung & Blood Institute. A/B
MACs (HHH) shall pay these claims if the patient’s arterial oxygen partial measurements
are from 56 to 65 mmHg, or whose oxygen saturation is at or above 89%.
History
(Rev. 2993, Effective: ASC X12 - 01-01-12, ICD-10 - Upon Implementation of ICD- 10; Implementation: ASC X12 - 08-25-14, ICD-10 - Upon Implementation of ICD- 10)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
0d73407cf4c8ebea8460e58ff3c8ea174e7e6e10c165c924030b118733cf3b9c
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