Medicare Reimbursement

Home oxygen suppliers that participate in Medicare are obligated to provide equipment and supplies as prescribed by the physician. Transtracheal supplies including catheters and accessories are included in the durable medical equipment allowance, and the Medicare home oxygen therapy rules are explained in the booklet Home Oxygen Therapy (» ICN 908804). Medicare also has a one-page summary of benefits for home oxygen equipment and accessories (» Coverage). Advantage Plans (like an HMO or PPO) must provide the same items and services as Original Medicare (» Avantage Plans). The physician can facilitate the timely replacement of transtracheal catheters and supplies by prescribing home oxygen with a precisely worded Detailed Written Order (» SCOOP Rx Template), or a revised certificate of medical necessity for transtracheal catheters and related supplies.

The Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and requires payment for home oxygen therapy with a single monthly allowance that includes the oxygen equipment and all necessary supplies. The law does not permit separate payment for any additional items, such as transtracheal catheters, nasal prongs, masks, tubing, or humidifiers needed to deliver oxygen to a patient since the monthly durable medical equipment allowance already covers such devices. During the first three years of the five-year global fee cycle, all participating oxygen suppliers are obligated without additional reimbursement to provide two transtracheal catheters and a transtracheal hose every 90 days as prescribed in the physician. Although Medicare payment for oxygen equipment generally stops after 36 months, the supplier is required to continue providing oxygen contents and supplies as prescribed for the remainder of the 5-year cycle.

Patients are advised to confer with their home oxygen supplier when considering changing from nasal prongs to transtracheal oxygen. To avoid problems with payment and delivery of transtracheal supplies, the patient should know whether or not the supplier participates in Medicare (» Medicare Supplier Directory). If they do, they cannot issue an advance written notice of noncoverage (» ABN) to charge a patient for transtracheal supplies since these items are included in the Medicare bundled payment for home oxygen equipment and supplies. If the supplier does not provide transtracheal supplies in a timely fashion as prescribed by the physician, the patient is invited to contact us by email at help@tto2.com or by telephone at 303-790-4766 or 800-527-2667. The patient may also consider filing a complaint with Medicare (» Complaint).