2025 HCPCS code QG

Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (LPM).

Refer to the latest HCPCS and Medicare guidelines for proper usage and reporting of this modifier.

Medical necessity for oxygen therapy must be established.The documentation should clearly demonstrate that the prescribed amount of oxygen is necessary for the patient's condition and that other treatment options have been considered.

The healthcare provider prescribing the oxygen is responsible for determining the appropriate flow rate and for documenting the medical necessity for the prescribed amount of oxygen.

IMPORTANT If portable oxygen is also prescribed in addition to the stationary oxygen exceeding 4 LPM, modifier QF may be applicable.If the prescribed flow rate varies between daytime and nighttime use, and the average exceeds 4 LPM, modifier QR may be used. For oxygen amounts less than 1 LPM, consider modifiers QA or QE.

In simple words: This code is used when a patient needs a high amount of oxygen at rest (more than 4 liters per minute) from a stationary oxygen supply. It helps ensure the medical equipment supplier receives the correct payment.

This modifier indicates that the prescribed amount of stationary oxygen, while the patient is at rest, exceeds 4 liters per minute (LPM).This modifier is used to adjust the monthly payment amount for stationary oxygen, typically increasing it. It is important for proper reimbursement as it reflects a higher level of oxygen requirement.

Example 1: A patient with severe COPD requires 5 LPM of oxygen at rest from a stationary oxygen concentrator.Modifier QG is appended to the HCPCS code for the oxygen equipment to indicate the increased oxygen requirement and adjust the payment accordingly., A patient with chronic respiratory failure is prescribed 6 LPM of oxygen at rest through a stationary oxygen system. The physician uses modifier QG to ensure accurate billing for the oxygen provided., A patient recovering from pneumonia requires a high flow of oxygen at 8 LPM while at rest. Modifier QG is used along with the appropriate oxygen equipment HCPCS code.

Documentation should support the medical necessity for the prescribed oxygen flow rate exceeding 4 LPM. This may include, but is not limited to, oxygen saturation levels, arterial blood gas results, and the patient's diagnosis.

  • Revenue Code: 0603 (for Home Health Agencies/HHAs)
  • Payment Status: Active
  • Specialties:Pulmonology, Respiratory Therapy, Internal Medicine, Sleep Medicine, Critical Care Medicine
  • Place of Service:Home
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