Home oxygen therapy is used to treat and prevent symptoms and complications of hypoxemia, and for treatment of certain other medical conditions.
The following providers may provide oxygen equipment:
• Medical suppliers
• Home health agencies
• Indian Health Services
• Federally qualified health center
• Rural health clinic
Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to help recipients for whom MHCP is not the primary payer.
MHCP quantity limits and thresholds apply to all recipients unless they are requesting only Medicare coinsurance or deductible.
Medicare payment for oxygen equipment is limited to 36 months. Providers may not bill MHCP for oxygen equipment supplied to Medicare beneficiaries when the 36-month cap is reached. Providers may not transfer dual eligible recipients to the contract provider when the 36-month cap is reached. Follow Medicare policy when serving dual eligible recipients.
DHS contracts for oxygen equipment and supplies. Contract vendors may supply only in their designated contract regions. Refer to the current volume purchase contract (PDF).
Non-contract oxygen vendors may provide oxygen only if one of the following exceptions applies:
• Recipients who are dually eligible for Medicare or other insurance coverage and MHCP may use non-contract vendors for their oxygen supplies. If Medicare or other insurance denies coverage because the recipient does not meet coverage criteria, the non-contract vendor must refer the recipient to a contract vendor within 30 days unless another exception applies. If Medicare (or other insurance) denies coverage because the recipient has met the 36-month coverage limitation, the provider may not transfer the patient to the contract provider.
• Recipients using respiratory life support equipment that requires oxygen as a driver or power source to sustain life, or using oxygen in conjunction with life support equipment in the home, may obtain oxygen from the provider who supplies the respiratory life support equipment.
• Recipients found retroactively eligible for MHCP. Non-contract oxygen vendors will be reimbursed for oxygen services at the contract rate for services provided during the retroactive eligibility period through the date the county determines eligibility for MHCP. When MHCP eligibility is determined, the non-contract vendor must refer the recipient to a contract vendor within 30 days unless another exception applies.
• LTC facilities that do not include oxygen in the per diem rate and own piped gas systems. LTC facilities may purchase gaseous oxygen from non-contract vendors and may bill MHCP for the oxygen contents at the contract rate.
• Recipients who are traveling outside of Minnesota for reasons other than medical care approved by MHCP may make arrangements with any MHCP enrolled provider who is willing to serve them if the contract vendor will not provide oxygen while the recipient is out of state. The recipient must notify the contract vendor prior to departure. The recipient must cooperate with the contract vendor if the contract vendor chooses to pick up oxygen equipment during the recipient’s time out of state.
DHS and Department of Administration representatives meet with volume purchase vendors as needed to discuss contract implementation and issues. Concerns about the volume purchase contracts should be directed, in writing, to:
Minnesota Department of Administration
Materials Management Division
112 Administration Building
50 Sherburne Avenue
St. Paul, MN 55155
Oxygen is covered for eligible MHCP recipients who meet medical necessity criteria.
Codes: E0424, E0431, E0434, E0439, E0441-E0444, E1390, E1392, S8120-S8121 – Oxygen equipment and contents; E1399 with modifier QH – oxygen conserving device
Oxygen and oxygen equipment is covered in the following circumstances:
• When the recipient’s blood oxygen levels indicate the need for oxygen therapy and one of the following is present:
• Diagnosis of severe lung disease such as chronic obstructive pulmonary disease, diffuse interstitial lung disease, cystic fibrosis, bronchiectasis, etc.
• Diagnosis of hypoxia-related symptoms caused by an underlying medical condition such as pulmonary hypertension, congestive heart failure, erythrocytosis, etc.
• Short-term need due to diagnosis of conditions that usually resolve with limited oxygen therapy such as pneumonia, croup, bronchitis, etc.
• The recipient has a diagnosis not directly related to hypoxia for which short-term or intermittent use of oxygen has been shown to be beneficial:
• Cluster headaches when other treatment has failed and the recipient has expressed a willingness to keep portable oxygen accessible throughout the day. If the recipient is not willing to keep portable oxygen accessible while away from home, oxygen is not an appropriate treatment.
• Pediatric bronchopulmonary dysplasia where the need for oxygen is variable and cannot be clearly established with blood oxygen levels.
• Hemoglobinopathies in patients with a history of vaso-occlusive crises.
MHCP does not require specific PaO2 or oxygen saturation values for coverage. The physician’s order must clearly state the recipient’s diagnosis, the PaO2 or oxygen saturation levels, the ordered flow rate and number of hours per day that oxygen is required.
MHCP does not cover the following:
• Oxygen purchased from airlines for use during travel.
• Stands, racks, and wheeled carts for oxygen equipment are not separately covered.
• Replacement accessories for portable concentrators are not covered because MHCP does not purchase portable concentrators.
Authorization is required for rental of a portable oxygen concentrator. A portable oxygen concentrator will be authorized only for recipients for whom MHCP has authorized out–of-state medical care requiring air travel. Authorization is not required for other oxygen equipment or for oxygen contents.
Submit authorization requests and required documentation to the authorization medical review agent.
• Use MN−ITS 837P Professional. Refer to the MN−ITS User guide for Durable Medical Equipment, Medical Supplies, Prosthetics and Orthotics for billing instructions.
• For gaseous oxygen systems when MHCP is primary payer, E0424 includes 50 cubic feet of gaseous contents. Use S8120 for all additional gaseous contents.
• For liquid oxygen systems when MHCP is primary payer, E0439 includes 10 pounds of liquid contents. Use S8121 for all additional liquid contents.
• When MHCP is not the primary payer, bill MHCP the same way the primary payer is billed.
• For all claims except Medicare crossover claims, payment is limited to the MHCP contract rate for the recipient’s county of financial responsibility (usually the county of residence).
• Do not bill disposable accessories separately. The cost of disposable accessories is included in the contracted rates for gaseous and liquid oxygen systems. This applies to both contract and non-contract vendors.
• Medicare does not cover the rental or purchase of oxygen equipment or contents when the recipient is living in a long-term care facility. Providers must follow MHCP billing procedures, including MHCP instructions regarding S8120 and S8121 for excess quantities of contents. It is not necessary to bill Medicare before billing MHCP.
Claims for MinnesotaCare recipients experiencing a temporary break in managed care coverage will deny for pricing reasons. Contact the MHCP Provider Call Center and request a work order to send the claim for review and possible payment.
Minnesota Statutes 256B.04, subd. 14 Competitive bidding
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Minnesota Statutes 256B.0625, subd. 31. Covered Services
Minnesota Rules 9505.0310 Medical Supplies and Equipment