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Code Home Oxygen Use for Cluster Headaches

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  • In Coding
  • January 28, 2011
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The Centers for Medicare & Medicaid Services (CMS) updated, Jan. 14, a national coverage determination (NCD) to add home use of oxygen to treat cluster headaches as a Part B durable medical equipment (DME) benefit when performed under a clinical trial.

As per the NCD for Home Use of Oxygen (240.2.2), Medicare will cover in-home oxygen treatments only when furnished to Medicare patients diagnosed with cluster headaches (based on the diagnostic criteria used by the International Headache Society) who are participating in an approved clinical study comparing normobaric 100 percent oxygen (NBOT).
Cluster headaches are characterized by severe stabbing pain in the head, usually behind one or both eyes, often accompanied by redness and tearing of one or both eyes, and nasal congestion. For cluster headache treatment to be covered by Medicare, a patient must have had at least five severe to very severe unilateral headache attacks lasting 15-180 minutes when untreated, and fulfill at least one clinically appropriate comparator (see the NCD).
Currently, there are no clinical trials approved or pending approval for the home use of oxygen for cluster headaches. In any event, should you find yourself coding a claim for in-home use of oxygen for treatment of cluster headaches, for claims with dates of services on or after Jan. 4, 2011, you should report the following:

  • HCPCS Level II code E1399 Durable medical equipment, miscellaneous with clinical trial procedure code modifier Q0 Invest clinical research;
  • ICD-9-CM diagnosis code 339.00 Cluster headache syndrome, unspecified, 339.01 Episodic cluster headache or 339.02 Chronic cluster headache;
  • clinical trial ICD-9-CM diagnosis code V70.7 Examination of participant in clinical trial;
  • Place of Service (POS) code 12 Home; and
  • The eight-digit clinical trial number (optional).

No other changes to NCD 240 were made and no updates to the Medicare Claims Processing Manual were necessary due to this coverage update.
Source: CMS Transmittal 130, Change Request (CR) 7235

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