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May 22, 2020

Oxygen and Infusion Pumps: CGS and Noridian COVID-19 Claims that were Submitted Without a Certificate of Medical Necessity or DME MAC Information Form (DIF) and Denied

With the recent COVID-19 Public Health Emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) is allowing Medicare beneficiaries to obtain DME oxygen equipment without a Certificate of Medical Necessity (CMN) for oxygen and without a DME MAC Information Form (DIF) for external infusion pumps.

This includes claims affected by the COVID-19 PHE and is for claims for dates of service beginning March 1, 2020 through the duration of the PHE.

The claim should be submitted with CR modifier and COVID-19 as the narrative.

If the claim is denied due to a missing CR modifier or narrative these claims can be corrected with Noridian and CGS as Written Reopenings. Noridian will also accept these claims through Telephone Reopenings.

Related HCPCS

Oxygen: E0424, E0425, E0430, E0431, E0433-E0435, E0439, E0440-E0447, E1390-E1392, E1405, E1406, K0738

Infusion Pumps: E0779-E0781, E0784, E0787, E0791, E1399, K0455


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