Definition
Oxygen Concentrator
An oxygen concentrator is a medical device that extracts oxygen from ambient air, filters it, and delivers a concentrated stream of oxygen (90%-95%) to patients who require supplemental oxygen therapy.
What CPT code is an oxygen concentrator billed with?
CPT Code E1390 is used for stationary oxygen concentrators, while E1392 refers to portable oxygen concentrators.
Who sets up PBA?
*First person that receives the claim for that CPT code * please add a patient note so processors can use it as guidance they will have to correct start date with first claim DOS
What does DME stand for?
Durable Medical Equipment
Modifier
RR
NU
RENTAL
PURCHASE
The plan can approve lifetime coverage for an oxygen concentrator with DX U07.1- COVID 19
False, COVID-19 is a short-term condition. We should only review for 10 mo rent to purchase
I received a sleep study for an oxygen concentrator I can internally approve Oxygen Concentrator since patient has an AHI of 20.
True or False.
False- Sleep studies are reviewed for ____ DME.
What does PPO stand for ?
Preferred Provider Organization
What is Hypoxemia?
Hypoxemia is a condition caused by low levels of oxygen in the blood which can lead to various symptoms and health risk
The plan only covers one oxygen concentrator; we cannot pay for a portal one.
False, the plan can cover both but what is required?
CPT CODES
APPROVED MESSAGE
DATE RANGE
CORRO REF OR UM
INITIALS
EOB
Explanation of Benefits
What is a " short term " condition?
Bonus: Give an example of a short-term condition
A short-term condition is a sudden onset temporary condition
EX: Pneumonia etc.
Please use your resources to review if the diagnosis on the RX received is short term or long term.
For lifetime approved oxygen concentrator, an adjuster must manually recalibrate the accumulators every 2 years.
TRUE OR FALSE
No need once long term is verified and approved PBA should be set up for eternal date and monies.
ex: 09/9/2999 monies: 999,999,999
If a condition is a short-term medical condition for an oxygen concentrator how many months do we set the PBA for?
Rent to purchase price- 10 month rental
PBA
Patient Based Accumulators
What is a "Long Term" condition?
Bonus: Give an example of a long term
A long-Term condition is for chronic, severe, ongoing conditions.
Ex: Chronic Lung Disease etc.
Please use your resources to review if the diagnosis on the RX received is short term or long term.
What is an "Acute" illness?
An acute illness is characterized by a rapid onset of symptoms and a relatively short duration, typically lasting from a few days to a few weeks. Unlike chronic illnesses, which persist over a longer period, acute conditions often resolve with prompt treatment or may improve on their own.
If a condition is a long-term medical condition for an oxygen concentrator how many months do we set the PBA for?
We can approve for lifetime.
Please indicate long term dx in your corro/ notes
CMS
Bonus: Who is CMS? What do they do?
Centers for Medicare & Medicaid Services.
Bonus: CMS is a federal agency that administers the nation’s major healthcare programs including Medicare and Medicaid.