[Regina]

I know my friends at HMETalk will be able to help me with this. Does anyone know the current reimbursement rate for E0439 prescribed at more than 4LPM? PDAC doesn't have it, and told me to call my DME MAC. I called Region A, and they couldn't help me either. The patient also has portable. I am in PA, but any help anyone can give me would be much appreciated!

[DMEisgoodfun]

Q16: Could you provide me with further clarification on the pricing
differential for the QE, QF and QG modifiers?
A16: There is an additional allowance when the beneficiary is using greater
than four liters per minute (LPM) of oxygen and was tested on four LPM of
oxygen. The QF modifier indicates the beneficiary meets this requirement and
a portable system is prescribed. The QG modifier indicates the same, except
a portable system is not prescribed. The reimbursement is increased by 50%
of the standard allowance for both QF and QG. The QE modifier indicates the
beneficiary is using less than one LPM. The reimbursement is 50% less then
the standard allowance.

[Regina]

thank you so much!

[blyons]

When the order is for 6lpm......and the pt is tested "on 4lpm", as required by Medicare, DOES THE 4lpm SAT NEED TO BE 88% OR less thus justifying that the higher payment category is needed????

We have a pt the was tested on 4lpm (resting) and the result was 96 and entered on the CMN.
The order is actually 4lpm cont, 6lpm ambulating. Should the pt have been tested on 4lpm ambulating???????????

[leejgbt]

The test done on 4LPM does indeed have to be a qualifying o2 sat.

[blyons]

Does the pt also need to ambulated on the perscribed liter flow to demonstrate improvement??
ie... RA Rest - 82% (CMN entry)
On 4 LPM Rest - 92%
On 4LPM exercising - 86% (CMN entry)

Do we need documentation of:
On 6LPM exercising - 91%

Help! Can't get an answer from Medicare....
Thanks!

[leejgbt]

No, you do not need all those tests. You need the 88% or less on 4 lpm. But remember you have to choose between getting the 50% bump in reimbursement and no portable system reimbursement or billing at the regular rate for both.
Can anyone forsee an RUL issue with not billing for the portable system????