O2 for Cluster Headaches Paid After Oct. 1

Home oxygen for cluster headaches (CH) will be reimbursed for up to 36 months beginning Oct. 1, the Centers for Medicare & Medicaid Services (CMS) recently announced.  The move follows a Jan. 14 transmittal announcing clinical studies.

Codes and modifiers to be used for the service are now outlined and include:

E0424 Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
E0441 Stationary oxygen contents, gaseous, 1 month’s supply = 1 unit
E0443 Portable oxygen contents, gaseous, 1 month’s supply = 1 unit
QF Prescribed amount of oxygen exceeds 4 liters per minute (LPM) and portable oxygen is prescribed
QG Prescribed amount of oxygen is greater than 4 liters per minute (LPM).

Please note that for the treatment of CH, this policy refers to the use of gaseous oxygen equipment and contents only. The usual dosage of oxygen for the treatment of CH is between 6-12 liters per minute. Modifiers QG or QF will be used with E0424 to adjust the monthly stationary oxygen payment amount to recognize that oxygen is prescribed for CH at a rate that exceeds 4 liters per minute. During the 36 month rental period:

  • If the beneficiary is prescribed stationary gaseous oxygen at a rate that exceeds 4 LPM, suppliers may use modifier QG with E0424 to increase the monthly stationary oxygen payment amount by 50 percent.
  • If the beneficiary is prescribed both stationary and portable gaseous oxygen at a rate that exceeds 4 LPM, suppliers may use modifier QF with E0424 to increase the monthly stationary oxygen payment amount by 50 percent, in accordance with the payment rules found in the Medicare Claims Processing Manual, chapter 20 (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)), section 130.6 (Billing for Oxygen and Oxygen Equipment).

A separate monthly payment is not allowed for the portable gaseous oxygen equipment described under E0431 Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing.

For more information about coding home oxygen for cluster headaches, go to “Code Home Oxygen Use for Cluster Headaches” on AAPC News.

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