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May 20, 2025

Widespread Pre-Pay Service Specific Medical Record Review Announcement – HCPCS Code E1390

CGS will conduct a medical record pre-pay review of claims that have the code E1390 and associated codes with the N3 modifier:

  • E1390 – OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE
  • N3 MODIFIER – GROUP 3 OXYGEN COVERAGE CRITERIA MET

The Oxygen policy group ranks high in Comprehensive Error Rate Testing (CERT) errors for Jurisdiction B and Jurisdiction C. Data analysis also showed multiple suppliers using the N3 modifier more than expected.

CGS will review medical records for about 100 randomly chosen claims before payment. This review does not target any specific supplier or provider.

CGS will send Additional Documentation Requests (ADR) for these claims. It is important to respond to ADR letters. Federal Law at SSA 1815(a), 1833(e), and 1862(a)(1) (A) authorizes the collection of this information. Suppliers are in violation of Supplier Standard #28 when, upon request, they fail to provide requested documentation to a Medicare contractor like CGS.

Failure to provide records may result in a claim denial and referral to either or both the National Provider Enrollment (NPE) contractor and UPIC.

The ADR letter will have the following information:

  1. Treating practitioner's written order
  2. Documentation to support the statutory and reasonable and necessary criteria; defined in the Local Coverage Determination and related Policy Article
  3. Any other pertinent documentation
  4. Copy of Advance Beneficiary Notice (ABN), if one was obtained

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