R09.02 — Hypoxemia
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Medical necessity for oxygen and oxygen equipment must be documented in the medical record according to the requirements of the related Local Coverage Determination (LCD).
- A treating practitioner's order is required to justify a change in equipment modality, and a beneficiary must sign an Advance Beneficiary Notice (ABN) when electing an upgrade that may not be covered.
- For a break-in-need that could restart a rental period, new medical necessity must be established and documented in the medical record.
- Suppliers must retain documentation of the initial date of service and rental history to calculate the RUL and rental-period eligibility.
Key Coverage Criteria
- Oxygen and oxygen equipment are covered under the Durable Medical Equipment (DME) benefit when reasonable and necessary as documented per the related Local Coverage Determination (LCD) and all Medicare statutory and regulatory requirements are met.
- When the reasonable useful lifetime (RUL) end date of stationary oxygen equipment occurs, the beneficiary may elect simultaneous replacement of both stationary and portable oxygen equipment, which starts a new 36-month rental period and a new RUL for both items.
- If portable oxygen use begins after stationary equipment use began, payment for the portable equipment may continue beyond the end of stationary equipment payments until 36 monthly rental payments have been made for the portable equipment.
- Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
- CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
- CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
20 Active Policies
L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
J05
L33405 — Polysomnography and Sleep Testing
J09
A57496 — Billing and Coding: Polysomnography and Sleep Testing
J09
Related Codes
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