Get Ready! CMS Is Introducing More Specific Pricing Modifiers for Oxygen Flow Rate

Thu, Mar 22, 2018 --

Coding Updates

CMS plans to revise and introduce new pricing modifiers for oxygen flow rate. So if you submit claims for oxygen services, make sure you and your billing staff members are aware of these changes effective April 1, 2018. Here’s a heads-up!

Why the Change?

Medicare has taken this step as the existing modifiers do not meet the needs of the market. There is a need to provide greater specificity in such modifiers where there are varying prescribed flow rates.

Which New Modifiers Are Coming?

The new HCPCS modifiers you’ll use April 1 are as follows:

  • 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 than 1 liter per minute (LPM))
    • You’ll use modifier QA when the prescribed flow rate varies for nighttime and daytime use. The volume adjustment is determined by the average of the two flow rates. The monthly payment for stationary oxygen reduces by 50 percent.
  • QB (… average of the two amounts exceeds 4 liters per minute (LPM) and portable oxygen is prescribed)
    • You’ll use modifier QB with both the stationary and portable oxygen equipment codes. The flow rate for the stationary equipment is the one used if prescribed stationary and portable flow rates differ. The stationary oxygen monthly payment goes up by either 50 percent of the monthly stationary amount or the fee schedule amount for the portable oxygen add-on, whichever is higher. You won’t get separate payment for the portable equipment when the stationary fee goes up 50 percent.
  • QR (… average of the two amounts is greater than 4 liters per minute (LPM)).
  • As far as modifier QR is concerned, the monthly payment amount for stationary oxygen goes up by 50 percent.

Make a Note of These Revised Modifiers

The agency also will make alterations to three existing modifiers in line with the regulations at 42 CFR 414.226(e)(3), which are about using the flow rate for the patient at rest when the prescribed rate is different at rest and at exercise. The changed modifiers are as follows:

  • QE(Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (LPM))
  • QF(… exceeds 4 liters per minute (LPM) and portable oxygen is prescribed)
  • QG(… greater than 4 liters per minute (LPM)).

Quick contrast: The descriptors for modifiers QA, QB, and QR include this phrase: Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ. Modifiers QE, QF, and QG refer only to “Prescribed amount of stationary oxygen while at rest.”

How About You?

Are you up to speed on the new oxygen modifiers?

About 

Barnali is a medical coding and billing writer at TCI who has worked in the healthcare industry since 2009. She holds a master’s degree in English literature and a diploma in advertising and marketing. She enjoys writing about ICD-10 and Medicare compliance.

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