The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment for the Medicare Physician Fee Schedule (MPFS) for Calendar Year (CY) 2009 on October 30, 2008. The release states that a comment period will last 60 days (through December 30,2008). The 1459 page document addresses new policies of the MIPPA, from initial preventative examinations to speech language pathology. Pages 837 - 859 relate to Section 144(b) of the MIPPA: Repeal of transfer of Title for Oxygen Equipment. A link to those pages is available below.

The information does not specifically address the traveling oxygen patient (snowbirds), change of payer in or out of a Hospice or HMO, however there is a general policy that there will not be a new 36 month cap rental period and that the original provider will be responsible for continuing service without a restart of 36 monthly payments. Changes in oxygen modalities was also not addressed. It does not provide new HCPCS Codes or prices for various services to be provided to patients after the cap. The report does address how oxygen service is covered and it is very unrealistic.

Payment for Oxygen Contents after the Rental Cap

"An oxygen supplier that furnishes liquid or gaseous oxygen equipment during a 36-month rental period must continue to furnish both the oxygen equipment and contents for any period of medical need for the remainder of the reasonable useful lifetime of the liquid or gaseous oxygen equipment established in accordance with §414.210(f)(1)."

- This may be interpreted that the provider "must continue to furnish...the contents"

Patient Relocation

"As noted in section III.J.2.a. of this final rule with comment period, we are revising §414.226(f) to specify that the supplier must make arrangements for the beneficiary to continue receiving the equipment if the beneficiary relocates at some time after the 36-month rental period but before the end of the reasonable useful lifetime of the equipment"

"in the case of liquid or gaseous equipment (stationary and portable) the supplier must make arrangements for the beneficiary to continue receiving oxygen contents if the beneficiary relocates at some time after the 36-month rental period but before the end of the reasonable useful lifetime of the liquid or gaseous equipment (stationary and portable). The supplier must make arrangements for the beneficiary to continue receiving the oxygen contents and equipment at his or her new residence."

- This may be interpreted that the supplier MUST or has to provide replacement equipment and contents if the patient relocates.

Maintenance and Servicing of Supplier-Owned Oxygen Equipment after the Rental Cap

"authorized payment for 30 minutes of labor for general maintenance and servicing of beneficiary-owned oxygen transfilling equipment and stationary or portable oxygen concentrators every 6 months..."

"Based on a careful review of this issue, as discussed below, we have determined that at this time it is not reasonable and necessary to pay for non-routine maintenance and servicing (including repair) of supplier-owned oxygen equipment. Given that the supplier owns the equipment, we believe that the supplier should be responsible for maintaining their equipment in working order as they did during the 36-month rental period."

"we will make payments when the supplier performs a routine maintenance and servicing visit following each period of continuous use of 6 months after the 36-month rental period ends."

"Payments for a routine maintenance and servicing visit in CY 2009 will be made when the beneficiary is at home or at a temporary residence (for example, a vacation residence). For each visit, we believe that it is appropriate to provide payment for 30 minutes of labor for general maintenance and servicing of oxygen equipment other than liquid or gaseous equipment (stationary and portable)."

Conversation with Christopher Molling

I spoke with Christopher Molling who is listed on page 8, as the contact for questions regarding the oxygen equipment. He confirmed as stated in the rule that service and maintenance could be billed for the first time on July 1, 2009, if the equipment caps in December of 2008. That payment for 30 minutes of service is approximately $30. It is only paid if the service is done and cannot be billed every 6 months whether service is provided or not. Travel time and delivery costs cannot be billed to Medicare.

Mr. Molling could not answer how disposables such as cannulas, filters and humidifiers bottles would be reimbursed and at what frequency. He also could not answer if we could charge the patient out of pocket if they request maintenance and service more than once every 6 months.

I asked if the comment period closes on December 30, when will the comments be addressed, unrealistic rules changesd and implemented. That could not be answered either.

The AMEPA office is sending a list of follow up questions to Mr. Molling as well as Joel Kaiser, Deputy Director of Policy for DMEPOS.

Click to read a portion of the report regarding oxygen