E0446 — Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- When billing for denial of related physician services on a Part B claim, enter '99199-related to Topical HBO' in the comment/narrative field (Loop 2400 or SV101-7 for the 5010A1 837P Item 19 and in Item 19 for paper claims).
- Reference CMS guidance: Change Request 10220, Transmittal 203, Transmittal 3921, and Internet-Only Manual Pub 100-04 Claims Processing Manual Chapter 32 Section 30.2 for policy authority and specific procedural/billing instructions.
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; for DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the supplier must receive a signed WOPD before delivery or the claim will be denied.
- Proof of delivery (POD) documentation must be maintained by the supplier and made available to the Medicare contractor on request; claims without appropriate POD will be denied.
Key Coverage Criteria
- Topical oxygen therapy for chronic wounds is not covered by a National Coverage Determination; coverage determination is made by the local Medicare Administrative Contractor (MAC).
- Initial coverage for home oxygen and oxygen equipment is reasonable and necessary only if the treating practitioner ordered and evaluated a qualifying blood gas study performed at the time of need, the study meets the coverage criteria, the study was performed by a treating practitioner or qualified provider/laboratory, and provision of home oxygen is expected to improve the beneficiary’s condition.
- Group I: Coverage if arterial PO2 ≤ 55 mm Hg or arterial oxygen saturation ≤ 88% at rest (awake) breathing room air.
- Group I (sleep-only): Coverage if arterial PO2 ≤ 55 mm Hg or arterial oxygen saturation ≤ 88% during sleep for a beneficiary who demonstrates PO2 ≥ 56 mm Hg or saturation ≥ 89% while awake, with oxygen reasonable and necessary only during sleep.
- Group I (sleep desaturation from baseline): Coverage if during sleep PO2 decreases >10 mm Hg or oxygen saturation decreases >5% from baseline and the decrease is associated with hypoxemia symptoms (e.g., cognitive impairment, nocturnal restlessness), with oxygen reasonable and necessary only during sleep.
- Group I (exercise): Coverage if arterial PO2 ≤ 55 mm Hg or saturation ≤ 88% during exercise for a beneficiary who demonstrates PO2 ≥ 56 mm Hg or saturation ≥ 89% at rest while awake; in this case portable oxygen is reasonable and necessary only while awake and during exercise.
12 Active Policies
L33797 — Oxygen and Oxygen Equipment
J19
AETNA-CPB-0172 — Hyperbaric Oxygen Therapy (HBOT)
AETNA-CPB-0788 — Alzheimer's Disease: Experimental Treatments
A56025 — Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines
UHC-POL-hyperbaric-topical-oxygen-therapy — Hyperbaric Oxygen Therapy and Topical Oxygen Therapy
Related Codes
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