New O2 Modifiers Effective April 2018

New O2 Modifiers Effective April 2018

There are new and changed modifiers to use if you are adjusting oxygen volume. The Centers for Medicare & Medicaid Services (CMS) updated an October Transmittal better defining how to report oxygen amounts below 1 liter per minute, which reduces the fee schedule monthly amount for stationary oxygen by 50 percent.

CMS’ rules for  volume adjustment say if “the prescribed amount of oxygen for stationary equipment exceeds 4 liters per minute, the fee schedule amount for stationary oxygen rental is increased by 50 percent. If the prescribed liter flow for stationary oxygen is different than for portable or different for rest and exercise, contractors use the prescribed amount for stationary systems and for patients at rest. If the prescribed liter flow is different for day and night use, contractors use the average of the two rates.”

If portable oxygen is prescribed, the fee schedule amount for portable equipment is added to the fee schedule amount for stationary oxygen rental.

The Adjustments Denoting the Modifiers

CMS defines the modifiers in this way:

  • 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 4LPM 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 if the stationary oxygen fee schedule amount is increased by 50 percent) Effective April 1, 2017, the modifier QF must be used with both the stationary and portable oxygen equipment codes.

New O2 Modifiers

CMS said they realized the current modifiers don’t meet the needs of the market, so they’ve added three new ones, which are 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 that 1 liter per minute (LPM)

QB Prescribed amounts of stationary oxygen for daytime used 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)

CMS also revised modifiers QE, QF, and QG to clarify that the prescribed flow rate at rest is used in accordance with regulations at 42 CFR 414.226(e)(3), which explains that if the prescribe flow rate is different for the patient at rest than for the patient at exercise, then the flow rate at rest is used.

Here are the changed modifiers:

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, CMS mandates that claims for monthly oxygen volume adjustments must indicate the appropriate HCPCS Level II 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 should use either of the following modifiers with the stationary oxygen HCPCS Level II code:

  • For modifier QE; HHAs use revenue code 0602. The monthly payment amount for stationary oxygen is reduced by 50
  • For modifier QA; 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

If the prescribed amount of oxygen is greater than 4 LPM, suppliers use either of the following modifiers with the stationary oxygen HCPCS Level II code:

  • For modifier QG; HHAs use revenue code 0603. The monthly payment amount for stationary oxygen is increased by 50 percent
  • For modifier QR; 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, CMS wants suppliers to use either of the following modifiers with both the stationary and portable oxygen HCPCS Level II code:

  • The modifier QF; 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 if the stationary oxygen fee schedule amount is increased by 50 percent. Effective April 1, 2017, the modifier QF must be used with both the stationary and portable oxygen equipment
  • The modifier QB; 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 separatemonthly payment is not allowed for the portable equipment if the stationary oxygen fee schedule amount is increased by 50 percent. Effective April 1, 2018, the modifier “QB” 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 April 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).

 

 

Brad Ericson

Brad Ericson

Director of Publishing at AAPC
Brad Ericson, MPC, CPC, COSC, has been director of publishing for more than 10 years. Before AAPC he was at Optum for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
Brad Ericson

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About Has 318 Posts

Brad Ericson, MPC, CPC, COSC, has been director of publishing for more than 10 years. Before AAPC he was at Optum for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

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