Providers Not Required to Submit CMN For Oxygen Claims During COVID-19 Pandemic

The change comes after CMS issued an interim final rule waiving clinical indication requirements for respiratory NCDs and LCDs.

Providers will not be required to submit a Certificate of Medical Necessity (CMN) for oxygen claims during the COVID-19 pandemic, DME MACs announced last week.

The change is a direct result of the CMS interim final rule issued in April, which waived the clinical indication requirements for respiratory National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

These exemptions also apply to external infusion pumps and will be effective for claims with dates of service starting on March 1 and lasting through the rest of the crisis, the American Association for Homecare said.

“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," Tom Ryan, AAHomecare CEO and president, said in a statement.

According to DME MAC guidelines, suppliers should still file oxygen and external infusion pump claims with the “appropriate modifiers,” which includes all HCPCS codes included in NCDs and LCDs. Providers are also instructed to enter “COVID-19” in the line note or claim note segments on the ANSI X12 format or field 390-BM on the NCPDP format.

Conversations between AAHomecare and CMS preceded the decision to waive the requirement, the organization said last week.

“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,” Ryan said.

About the Author

Haley Samsel is the Associate Content Editor of HME Business and Mobility Management.

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