According to the DME Index, PA is required for all oxygen-related services covered by these procedure codes, as follows:
Providers are required to submit both the PA/RF and the PA/OA for oxygen-related services, including stationary and portable oxygen systems, oxygen contents, and oxygen concentrators. PA requests for members who reside in nursing homes must include a Record of Actual Daily Oxygen Use form along with the PA/RF and PA/OA. Providers may also be required to submit additional supporting documentation, when applicable.
Providers may attach a photocopy of the physician's prescription to the completed PA/OA or the prescribing physician may sign and date the PA/OA in lieu of attaching the prescription. The prescription (or PA/OA) must be signed and dated within 30 days prior to the date of receipt by ForwardHealth or the requested start date of the PA request. Attach the PA/OA to the PA/RF and send it to ForwardHealth. Standing orders are not acceptable.
Providers are required to keep a copy of the physician's signed and dated PA/OA or the physician's signed and dated prescription in the member's file. As a reminder, the written copy must match what is stated in the PA request. Web PA users must type in the name of the person who is required to sign the forms for the elements that need a signature. Providers may print a copy of the forms submitted via the Portal and have them signed for their own records.
If a member is in an SNF, the PA request must include a record of the actual daily usage of oxygen for at least the first 15 days of the initial 30-day rental period. A provider should submit a PA request for a member in a nursing home even if the member does not use oxygen for 15 consecutive days within the 30-day period but uses it a minimum of 15 days within the 30-day period. The provider should explain the situation on the PA request. These PA requests are considered on a case-by-case basis.
When requesting PA, nursing homes are required to indicate with an "X" on the Record of Actual Daily Oxygen Use form each shift that a member uses oxygen or submit a copy of the nursing home's record of the member's oxygen use. Documentation of medication administration is required during every shift for prescription drugs (e.g., oxygen) administered in a nursing home by nursing home staff.
Providers currently are required to indicate the appropriate "Q" modifier on a PA request based on the flow rate indicated in the prescription. However, a specific flow rate is not always specified on the prescription for infants younger than 24 months.
PA requests may be approved without a modifier for infants younger than 24 months if the prescription does not specify a flow rate but specifies maintenance of a certain oxygen saturation level. This applies to the following oxygen systems:
Providers are required to submit a new PA request with a specified flow rate when the child reaches 24 months of age.