New Rental Period Decision Tree
This decision tree walks the supplier through whether a new rental period may begin for equipment that has set rental periods. It includes Oxygen, Wheelchairs and other equipment, as well as Enteral and Parenteral nutrition. Choose which tree is applicable depending on which type of equipment is being rented, then answer the questions. The tree will drill down to the correct outcome.
1. Is your inquiry about an interruption in capped rental for oxygen?
2. Was the equipment lost, stolen, or irreparably damaged in a specific incident?
Yes No
A new capped rental period may begin. Refer to the DME Supplier Manual
for information about replacement and documentation needed for replacement
3. Has the Reasonable Useful Lifetime for the equipment expired?
Yes No
A new capped rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
4. What was the reason for the interruption?
Break in Billing: The supplier is not billing Medicare FFS for the item but there is no change in Medical Necessity. (SNF, Home Health, Medicare Advantage Plan, HMO)
Break in Medical Necessity: There was a resolution of the condition that created the first period of medical necessity and there was subsequent development of a second event that created a new period of Medical Necessity.
A new capped rental period would not begin. If a beneficiary enters a hospital/ SNF or enters Medicare HMO, upon return to FFS Medicare, billing will resume where it left off.
5. Did the break in medical necessity last more than 60 days plus the remainder of the rental month of discontinuation?
Yes No
A new capped rental period would not begin. If need/use of oxygen ends for less than 60 days plus the remainder of the rental month of discontinuation and then resumes, payment resumes where it left off. Oxygen and Oxygen Equipment - Policy Article
6. Did the break in medical necessity occur during the 36-month rental period?
Yes No
A new capped rental period would begin. A treating practitioner’s order is needed to reaffirm the medical necessity of the item. View the associated Policy Article for more information. Oxygen and Oxygen Equipment - Policy Article
A new capped rental period would not begin. During months 37-60, if need/use of oxygen ends for more than 60 days plus the remainder of the rental month of discontinuation and new medical necessity is established, a new rental period does not begin. The supplier who provided the oxygen equipment during the 36th rental month must provide all necessary items and services for the duration of the reasonable useful lifetime. Oxygen and Oxygen Equipment - Policy Article
2. Is your inquiry about an interruption in the rental period for Enteral and Parenteral Pumps?
Yes No
3. Has the Reasonable Useful Lifetime (8 years) expired?
Yes No
A new 15-month rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
4. Are you seeking a new 15-month rental period due to a change in the supplier?
Yes No
Change in Supplier does not begin a new 15-month rental period whether the rental period has completed or not.
Change in Supplier during the 15-month rental period: The new supplier is entitled to the balance remaining on the 15-month rental period.
Change in Supplier after the 15-month rental period: The supplier that collects the last month of rental (i.e., the 15th month) is responsible for ensuring that the beneficiary has a pump for as long as it is medically necessary and for maintenance and servicing of the pump during the period of medical necessity.
Refer to the DME Supplier Manual, Chapter 5, for more information.
5. Was the equipment lost, stolen, or irreparably damaged in a specific incident?
Yes No
A new 15-month rental period may begin. Refer to the DME Supplier Manual for information about replacement and documentation needed for replacement.
6. Was the pump rented or purchased?
Rented Purchased
7. Has the 15-month rental limit been reached?
Yes No
8. Has the attending physician changed the prescription between parenteral and enteral nutrients?
Yes No
A new 15-month rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
9. Did the medical necessity for the use of the pump end for two consecutive months?
Yes No
A new 15-month rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
A new 15-month rental period may not begin. Please refer to the appropriate Policy Article for specific information on when a new 15-month rental period would begin.
8. Did the medical necessity for the use of the pump end for two consecutive months?
Yes No
A new 15-month rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
A new 15-month rental period may not begin. Please refer to the appropriate Policy Article for specific information on when a new 15-month rental period would begin.
7. Has the attending physician changed the prescription between parenteral and enteral nutrients?
Yes No
A new 15-month rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
8. Did the medical necessity for the use of the pump end for two consecutive months?
Yes No
A new 15-month rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
A new 15-month rental period may not begin. Please refer to the appropriate Policy Article for specific information on when a new 15-month rental period would begin.
3. Has the Reasonable Useful Lifetime for the equipment expired?
Yes No
A new capped rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
4. Was the equipment lost, stolen, or irreparably damaged in a specific incident?
Yes No
A new capped rental period may begin. Refer to the DME Supplier Manual for information about replacement and documentation needed for replacement.
5. What was the reason for the interruption?
Break in Billing: The supplier is not billing Medicare FFS for the item but there is no change in Medical Necessity. (SNF, Home Health, Medicare Advantage Plan, HMO)
Break in Medical Necessity: There was a resolution of the condition that created the first period of medical necessity and there was subsequent development of a second event that created a new period of Medical Necessity;
or
The beneficiary's medical condition has changed creating the need for a different item.
A new capped rental period does not start if the interruption in billing was not due to a change in medical need.
6. Was the interruption in use longer than 60 consecutive days plus the days remaining in the rental month (not calendar month, but the 30-day rental period)?
Yes No
A new capped rental period may begin. A new order is required along with a narrative and proper modifiers. Also refer to the specific guidelines outlined in the LCD/PA.
You may also refer to the Claim Narratives Chart for guidance for proper narratives.
7. Is the item being billed DESCRIBED BY A different HCPCS code from the previous capped rental item?
Yes No
A new capped rental period would begin IF there has been a change in the beneficiary's MEDICAL condition that necessitates a significantly different item.
Refer to the Claim Narratives Chart for proper narratives and to the associated LCD and Policy article for modifiers and other information.
A new capped rental period would not start.
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