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License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

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The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
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April 26, 2018

Retired: Billing Instruction – Oxygen CMN Question 5 – Revised

Joint DME MAC Article

On February 15, 2018 the DME MACs published an article entitled "Billing Instruction - Oxygen CMN Question 5" with supplier guidance on use of new oxygen "Q" modifiers and the Certificate of Medical Necessity (CMN) (CMS-484/DME 484.3) form.  The article provided instructions for providers to report the calculated average flow rate for Question 5 on the CMN form when there are differing daytime and nighttime prescribed flow rates.  In addition, the article instructed suppliers to submit revised CMNs in this situation for dates of service (DOS) on or after April 1, 2018.  The instruction to submit revised CMNs is being rescinded.  Suppliers should educate providers completing the oxygen CMN to follow the instructions included on page 2 of the CMN.  As a reminder, the instructions on the Oxygen CMN for Question 5 state:

  1. Enter the highest oxygen flow rate ordered for this patient in liters per minute. If less than 1 LPM, enter an "X".

For DOS on or after April 1, 2018, suppliers must still use the appropriate "Q" modifier on claim lines for oxygen equipment. Those modifiers are:

  • QE - PRESCRIBED AMOUNT OF STATIONARY OXYGEN WHILE AT REST IS LESS THAN 1 LITER PER MINUTE (LPM)
  • QF - PRESCRIBED AMOUNT OF STATIONARY OXYGEN WHILE AT REST EXCEEDS 4 LITERS PER MINUTE (LPM) AND PORTABLE OXYGEN IS PRESCRIBED
  • QG - PRESCRIBED AMOUNT OF STATIONARY OXYGEN WHILE AT REST IS GREATER THAN 4 LITERS PER MINUTE (LPM)
  • QA - PRESCRIBED AMOUNTS OF STATIONARY OXYGEN FOR DAYTIME USE WHILE AT REST AND NIGHTTIME USE DIFFER AND THE AVERAGE OF THE TWO AMOUNTS IS LESS THAN 1 LITER PER MINUTE (LPM)
  • QB - PRESCRIBED AMOUNTS OF STATIONARY OXYGEN FOR DAYTIME USE WHILE AT REST AND NIGHTTIME USE DIFFER AND THE AVERAGE OF THE TWO AMOUNTS EXCEEDS 4 LITERS PER MINUTE (LPM) AND PORTABLE OXYGEN IS PRESCRIBED
  • QR - PRESCRIBED AMOUNTS OF STATIONARY OXYGEN FOR DAYTIME USE WHILE AT REST AND NIGHTTIME USE DIFFER AND THE AVERAGE OF THE TWO AMOUNTS IS GREATER THAN 4 LITERS PER MINUTE (LPM)

Suppliers must ensure that the appropriate "Q" modifier is used, based on information in the beneficiary's medical record. Suppliers cannot bill for oxygen using the "Q" modifier until compliance with the regulations at 42 CFR Section 414.226(e) has been documented in the beneficiary's record. That regulation stipulates that:

  1. If prescribed flow rate is different for stationary versus portable, the flow rate for stationary is used.
  2. If prescribed flow rate is different for the patient at rest versus the patient with exercise, the flow rate at rest is used.
  3. If prescribed flow rate is different for nighttime versus daytime use, the flow rates are averaged.

For beneficiaries with a single prescribed flow rate that doesn't encompass a full 24 hours, an average calculation is still required with the unaccounted for portion of the 24 hour period set equal to "0". For example, if the only available prescribed flow rate is nocturnal at 2 LPM, a "0" is reported for the prescribed daytime flow rate. Calculating the average of the night and day use yields an average reportable prescribed flow rate value of 1 LPM. In order to properly calculate the average flow rate used to determine the appropriate "Q" modifier, the following example is provided:

(day flow rate + night flow rate) / 2 = average flow rate
(apply arithmetic rounding rules, if necessary)

In no case can a prescribed flow rate for exercise be used, either alone or in conjunction with a prescribed flow rate for nighttime use, to determine whether or not a low (less than 1 LPM), high (more than 4 LPM), or other (more than 1 LPM but less than 4 LPM) prescribed flow rate applies for Medicare payment purposes.

Since the "Q" modifiers submitted on the claim will be used in determining the applicability of the volume adjustment payment, suppliers cannot bill for oxygen until compliance with the regulations has been documented in the beneficiary's record. Oxygen volume adjustment claims where the medical record is not in compliance with regulatory policy constitutes fraudulent billing and may be subject to penalties.

Refer to the Oxygen and Oxygen Equipment Local Coverage Determination (L33797External Website) and related Policy ArticlesExternal Website for additional information on coverage, coding and documentation requirements.

Publication History

Publication Date: February 15, 2018
Originally Published

Publication Date: April 26, 2018
Revised: Removed Revised CMN instruction related to new "Q" modifiers

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