CMS Pub. 100-04, ch. 36, § 50.13

Cap

(Rev. 2231, Issued: 05-27-11, Effective: 08-28-11, Implementation: 08-28-11)

The Medicare law requires that the supplier that furnishes liquid or gaseous oxygen equipment

(stationary or portable) for the 36th continuous month must continue to furnish the oxygen

contents necessary for the effective use of the liquid or gaseous equipment during any period

after the payment cap and of medical need for the remainder of the reasonable useful lifetime

established for the equipment. This requirement continues to apply under the Medicare

DMEPOS Competitive Bidding Program, regardless of the role of the supplier (i.e., contract

supplier, grandfathered supplier, or non-contract supplier) and the location of the beneficiary (i.e.

residing within or outside a CBA).

Should a beneficiary travel or temporarily relocate to a CBA, the oxygen supplier that received

the payment for the 36th continuous month must make arrangements for furnishing oxygen

contents with a contract supplier in the CBA in the event that the supplier that received the 36th

month payment elects to make arrangements for a temporary oxygen contents billing supplier.

The Medicare payment amount is always based on the location in which the beneficiary

maintains a permanent residence. If the beneficiary resides in a CBA, payment for the oxygen

contents will be based on the single payment amount for that CBA. If the beneficiary resides

outside of a CBA and travels to a CBA, payment for the oxygen contents will be based on the

fee-schedule amount for the area where the beneficiary maintains a permanent residence.