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From HME Business 6/1/2019

Portable oxygen concentrator (POC) use in the United States has exploded over the years. As an example, according to Medicare HCPCS claims data, the portable oxygen concentrator code E1392 has been in use since 2007. In 2007, there were an estimated 1,500 patients receiving a POC billed to Medicare, and in 2016 approximately 114,400 beneficiaries received POCs in 2016.

That’s not surprising what POC’s mean for patients. The core value of the POC for patients has been that it is a self-generating oxygen system they can take with them. Like a stationary concentrator, a POC takes room air and through an electro-chemical process strips away the nitrogen that is part of that air to deliver concentrated oxygen. However, instead of being tethered to a stationary device, patients can go where they want and carry out daily activities. Now patients can get outside, and lead a fuller, more active lifestyle than they could without the portable oxygen concentrator. They can much more easily spend longer periods away from home and can even travel.

And of course, for providers, the upsides are also clear: With no tanks that need to be refilled, costly delivery overhead has been slashed. No longer do oxygen providers have to maintain vehicle fleet operations to continually distribute tanks. Even with the higher up-front costs of the POCs themselves, the positive impact to the bottom line is considerable.

However, a patient education challenge has arisen that oxygen providers need to address.


So what’s the challenge? To start, in cases with highly ambulatory and active patients, their POC often becomes their primary means to derive their long-term oxygen therapy. Conversely, there are patients who receive POCs but don’t use them. This presents a twin educational challenge providers must address: First, how do they educate the patients who aren’t using their POCs as often as they should on how to use the devices as well as actually getting out and using them? Second, how do they get the heavy users to keep being “super users,” but also understand their device limitations?


Retaining a respiratory therapist on staff is a critical education asset. Contracting with entrepreneur RTs clearly works and is a model used regularly, but a full-time RT can bring improved accountability for the care a provider offers, and enhance its patient education and provide disease management to the patient so that they better adhere to their treatment and benefit from it.

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Tuesday, June 25, 2019 @ 01:06 PM  posted by jbuytaert

Additional HCPCS Codes Added to Prior Authorization List

Thursday, April 25, 2019 @ 01:04 PM  posted by jbuytaert

courtesy of HomeCare Magazine
WASHINGTON, (April 18, 2019)T

The Centers for Medicare & Medicaid Services (CMS) has selected 12 additional items of Durable Medical Equipment (DME) to be subject to required prior authorization (CMS 6080-N2).

CMS is adding the following seven Healthcare Common Procedure Coding System (HCPCS) codes for power mobility devices (PMDs) to the Required Prior Authorization List: K0857, K0858, K0859, K0860, K0862, K0863 and KO864. Prior authorization for these PMDs will be implemented nationwide, beginning July 22, 2019.

CMS is adding the following five HCPCS codes for pressure reducing support surfaces (PRSS) to the Required Prior Authorization List: E0193, E0277, E0371, E0372 and E0373. Prior authorization for PRSSs will be implemented in two phases. Phase one will begin July 22, 2019. CMS will limit prior authorization to one state in each of the four DME MAC jurisdictions as follows: California, Indiana, New Jersey and North Carolina. Phase two will begin Oct. 21, 2019 and expands prior authorization of these codes to the remaining states and territories.

All HCPCS codes previously added to the Required Prior Authorization List will continue to be subject to the requirements of prior authorization.

In addition, CMS has provided the annual update to the master list of DMEPOS items that the Secretary determined, on the basis of prior payment experience, are frequently subject to unnecessary utilization (CMS 6078-N2). As noted in CMS 6050-F, the agency adjusts the payment threshold each year for inflation. This update adds the following four HCPCS codes to the master list because they meet the updated payment threshold and are listed in a CERT DME and/or DMEPOS Service Specific Report: E1390, E0466, E0784 and L0650.

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