2019 Fee Schedule: More Oxygen Cuts

CMS’s decision to apply budget neutrality offsets to 2019 fee schedule sees reimbursement reductions for a variety of oxygen codes.

After releasing an initial update to its 2019 fee schedules last week, CSM has released its full 2019 DMEPOS fee schedule, and initial review from the American Association of Homecare shows that some oxygen categories will significant changes.

Oxygen rates for 2019 will deviate from previous years because CMS decided to apply budget neutrality offsets to all oxygen and oxygen equipment classes. Respiratory stakeholders were waiting to see how these changes would hit rural and non-rural areas not in former competitive bidding areas.

“Our analysis shows significant differences in how stationary and portable oxygen concentrators fare in the 2019 fee schedule, as well as deeper cuts for portable gaseous systems,” a statement from the organization read. “These additional cuts for home oxygen therapy are certain to impact providers and patients in rural and other non-CBA areas.”

AAHomecare’s breakdown in the differences between 2018 and 2019:

E1390 (stationary O2 concentrator)

2018

2019

% Change

Rural Rate

$121.46

$134.71

10.9%

Avg Regional Rate

$69.31

$72.32

4.4%


E1392 (portable O2 concentrator)

2018

2019

% Change

Rural Rate

$46.77

$44.32

-5.2%

Avg Regional Rate

$38.10

$35.64

-6.5%


E0431 (Portable gaseous contents)

2018

2019

% Change

Rural Rate

$24.94

$24.00

-3.8%

Avg Regional Rate

$17.30

$16.17

-6.5%


K0738 (Portable gaseous O2 system)

2018

2019

% Change

Rural Rate

$46.77

$44.32

-5.2%

Avg Regional Rate

$37.77

$35.64

-5.7%

AAHomecare highlighted the fact that CMS has publicly stated that it does not have the authority to address the budget neutrality offset. As a result, fighting these offsets will have to become part of the industry’s legislative agenda in the New Year and beyond.

“… The HME community needs to make this a priority for advocacy efforts in the 116th Congress,” AAHomecare’s statement read.

Other Rate Analysis

AAHomecare also noted that CMS’s adjusted fee schedule for rural and non-contiguous, non-bid areas will increase their rates by 1.2 percent in 2019, based on the association’s analysis of the top 25 HCPCS codes. That analysis is available as an Excel spreadsheet as well as a PDF

Also, AAHomecare reports that competitive bid items in non-rural, non-bid will not receive any adjustment for inflation for 2019, but rates for non-competitive-bid items will receive an increase of roughly 2.3 percent.

Comments

Fri, Dec 21, 2018 Dan Heckman Decatur IL

Can’t wait til they factor in liquid oxygen to maintain budget neutrality. We’ll be doing E1390 concentrator for $15 a month.

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