Oxygen Equipment Requirements

As outlined in Highmark Wholecare’s medical policies and CMS requirements, reimbursement for oxygen equipment is limited to 36 monthly rental payments. When the stationary and portable oxygen equipment are replaced, a new 36-month rental period and reasonable useful lifetime (RUL) begins for both the replacement stationary and portable oxygen equipment.

A new 36-month rental period can begin only in the following situations:

• Specific incident of damage beyond repair (e.g., dropped and broken, fire, flood, etc.)
• The item is stolen or lost

A new 36-month rental period does not start in the following situations:

• Replacing equipment due to malfunction
• Wear and tear
• Routine maintenance and repair
• Providing different equipment based on a treating practitioner order or beneficiary request for an upgrade
• Break-in-need
• Break-in-billing
• Changing suppliers

Remember: All rental equipment must be billed with modifier RR.

At any time after the end of the 5-year RUL for oxygen equipment, the beneficiary may elect to receive new equipment, thus beginning a new 36-month rental period. For more information, please review CMS’ policy on Oxygen Equipment , the Medicare Claims Processing Manual, and Highmark Wholecare’s Medicaid and Medicare medical policies.