2025 HCPCS code E0431

Rental of a portable compressed oxygen system; includes container, regulator, flowmeter, humidifier, cannula/mask, and tubing.

Follow all applicable HCPCS coding guidelines for durable medical equipment (DME). Ensure proper documentation supports medical necessity and the selected code aligns with the supplied equipment and services.

Modifiers may apply depending on specific circumstances.Consult modifier guidelines and payer-specific instructions for appropriate modifier usage.

Medical necessity for portable oxygen is established by documentation of a chronic or acute respiratory condition requiring supplemental oxygen to maintain adequate oxygen saturation and alleviate symptoms.The physician must justify the need for a portable system based on the patient's mobility requirements and need for supplemental oxygen outside the home setting.

The physician must document the medical necessity for the portable oxygen system based on the patient's condition. This involves a direct encounter with the patient to assess their respiratory needs and determine the appropriateness of portable oxygen therapy.

IMPORTANT Should not be billed with K0738 (per Medicare guidelines).E0430 represents the purchase of a similar system.E0434 is for rental of a portable liquid oxygen system.

In simple words: This code covers renting a portable oxygen tank system. The system includes the tank, a device to control the oxygen flow, a humidifier to keep your nose from drying out, tubing, and a mask or nose piece.Your doctor must show that you need this equipment.

This HCPCS code covers the rental of a complete portable compressed oxygen system providing a variable oxygen concentration.The system includes a portable container (tank), regulator, flowmeter, humidifier, and connecting tubing to a nasal cannula or mask.The system is designed for portability and typically includes a carrying case or wheeled cart if the oxygen cylinder weighs more than 10 pounds.Oxygen tends to dry out mucous membranes; the humidifier helps prevent this dryness.The provider must document the direct patient encounter and the medical necessity for the DME order. Medicare coverage requires documentation of medical necessity.

Example 1: A patient with COPD experiencing chronic shortness of breath requires supplemental oxygen at home and during mobility.A portable oxygen system is rented to support their oxygen needs., A patient recovering from pneumonia requires short-term supplemental oxygen during rehabilitation at home.The portable oxygen system is rented for the duration of the recovery period., A patient with cystic fibrosis experiences periods of severe respiratory distress and requires portable oxygen support for both home use and mobility. The portable oxygen system is a necessary part of their treatment plan.

* Detailed patient history and physical examination findings supporting the need for portable oxygen.* Documentation of the patient's respiratory status (e.g., pulse oximetry, arterial blood gas results).* Explanation of the oxygen flow rate prescribed.* Documentation of the patient's activity level and mobility needs that necessitate portable oxygen.* Physician's order for the specific type of oxygen delivery system.

** Always check with the specific payer for their specific coding and reimbursement guidelines. The information provided here is for general guidance and may not be exhaustive.

  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Specialties:Pulmonology, Respiratory Therapy, Cardiology, Internal Medicine, Family Medicine
  • Place of Service:Home, Office
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