WASHINGTON, D.C. – On May 7, 2020, the DME MACs announced that the CMN for oxygen claims will not be required during this COVID-19 Public Health Emergency. This announcement implements CMS’ Interim Final Rule (CMS-1744-IFC) that waived the clinical indication requirements for respiratory NCDs (national coverage determinations) and LCDs (local coverage determinations) and provides DME suppliers with information on how to submit claims for home oxygen during the COVID-19 public health emergency.
In the May 7, 2020 Joint DME MAC announcement, the MACs clarified that the same CMN exemption applies to external infusion pumps. These changes are effective for dates of service starting March 1, 2020, through the end of the public health emergency.
The DME MACs explained how DME suppliers should file oxygen (and external infusion pump) claims without a CMN:
Suppliers should continue to use the appropriate modifiers, including the KX modifier where applicable, for all HCPCS codes included in the [relevant] NCDs and LCDs. In addition, the CR modifier (CATASTROPHE/DISASTER RELATED) should be added to the HCPCS code(s) billed. Finally, suppliers are instructed to enter “COVID-19” in the NTE 2400 (line note) or NTE 2300 (claim note) segments of the American National Standard Institute (ANSI X12) format or field 390-BM of the National Council for Prescription Drug Program (NCPDP) format. These abbreviations may also be used in Item 19 of the CMS-1500 claim form.
This announcement comes after extensive discussions the American Association for Homecare (AAHomecare) had with CMS. See the full DME MAC announcement here.
“This policy change will allow HME suppliers who provide respiratory and infusion services to provide more support to patients and family caregivers during this pandemic,” said Tom Ryan, AAHomecare President and CEO. “We appreciate CMS’s responsiveness and collaborative approach in modifying regulations to help ensure the HME community can make its strongest possible contribution to limiting the impact of the COVID-19 crisis.”
Cara C. Bachenheimer, J.D., is an attorney with Brown & Fortunato, P.C., where she heads up the firm’s Government Affairs Practice. Bachenheimer has been closely involved with the HME industry for 30 years, working in Washington, D.C., as well as on a grassroots basis across the country. In 2014, she was named Homecare Champion by the American Association for Homecare. She can be reached at 806-345-6321 and firstname.lastname@example.org.