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24.5.27.19 Oxygen Therapy Home Delivery System Types
The oxygen concentrator systems are the preferred (standard) delivery system of in-home oxygen therapy. This type of system concentrates oxygen molecules from the ambient air, generating concentrations of up to 90 to 98 percent.
Use procedure code L-E1390 for the rental of an oxygen concentrator system.
The reimbursement payment for the rental of the procedure code L-E1390 includes, but is not limited to, cannula or mask, tubing, and humidification. These items will not be reimbursed separately.
If other types of oxygen therapy home delivery systems are required, documentation of medical necessity exception must be provided.
Other types of delivery systems include:
• Compressed gas cylinder systems (nonportable tanks) (L-E0424).
•Liquid oxygen reservoir systems (L-E0439).
Note: The reimbursement for compressed gas cylinder and liquid oxygen reservoir systems includes all of the supplies that are noted in the procedure code description.
•Portable oxygen systems-Portable oxygen therapy may be authorized if the medical necessity conditions are met, and the medical documentation indicates that the client requires the use of oxygen in the home and would benefit from the use of a portable oxygen system when traveling outside the home environment.
•Portable oxygen systems are not considered a benefit of the Home Health Services Program for clients who qualify for oxygen solely based on blood gas studies obtained during sleep.
•Use procedure codes L-E0431, L-E0434, and L-K0738 when billing for the portable oxygen systems. When procedure code L-K0738 is billed for the same dates of service as procedure code L-E0431, procedure code L-E0431 will be denied.
•Rental of the portable oxygen system includes all supplies and refills. Refills for a client-owned system must be obtained from a DSHS-licensed vendor.
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