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Blue Cross of IdahoCommercial · Billing Codes · Medical Policy · ID · Pulmonology, Critical Care, Geriatrics +1 moreHigh impact

PAP209 - Oxygen and Oxygen Equipement - Unarchived policy - defined rental months, added rental codes, removed extra language

Effective date
Not stated in the notice
Identified
Jun 19, 2026

Summary

PAP209 was unarchived and revised to clarify oxygen and oxygen equipment billing under Medicare FFS rules adopted by Blue Cross of Idaho for commercial claims. The policy now explicitly defines rental month caps (36 months), adds specific HCPCS rental codes (E0424, E0425, E0439, E0440, E1353, E1390, E1391, E1405, E1406, E0430, E0431, E0433, E0434, E0435, E1392, K0738), and removes outdated language while adding detailed LCD references and modifier requirements.

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What to do

Action · 4 steps
01Billing team must immediately audit all active oxygen and oxygen equipment claims to ensure compliance with the 36-month rental cap rules and proper HCPCS modifier application (QA, QB, QE, QF, QG, QR).
02Update billing system validation to: (1) enforce the 36-month capped rental period for stationary equipment (E0424, E0425, E0439, E0440, E1353, E1390, E1391, E1405, E1406); (2) require appropriate modifiers per LCD L33797; (3) track rental month counts from initial date of service to prevent overpayment after month 36; (4) allow separate billing for oxygen contents (E0441, E0442, E0443, E0444) only after 36-month cap is reached; (5) implement 5-year RUL tracking that does not restart upon modality changes, supplier changes, or equipment replacement.
03Retrain billing staff on break-in-service rules (less than 60 days = resume payment; more than 60 days = new 36-month period only during months 1-36).
04Review and reject any claims submitted after March 2023 that do not comply with these capped rental and modifier requirements.
If missed: Failure to apply these rules will result in claim denials and potential overpayment recovery.

Codes mentioned

E0424E0425E0439E0440E1353E1390E1391E1405E1406E0430E0431E0433E0434E0435E1392K0738E0441E0442E0443E0444E1399

Original notice

PAP209 - Oxygen and Oxygen Equipement - Unarchived policy - defined rental months, added rental codes, removed extra language
providers.bcidaho.com · Always check the source before changing claims.
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Related changes

See all Blue Cross of Idaho changes →
PAP222 - Durable Medical Equipment/Prosthetics/Orthotics/Supplies (DMEPOS)Modifiers - Added clarifying languageMediumNo effective date · Medical PolicyBrowse every Blue Cross of Idaho change in the policy list

Related policy hubs

Blue Cross of Idaho policiesID policy changesPulmonologyCritical CareGeriatricsPalliative CareCode E0424Code E0425Code E0439Code E0440Code E1353Code E1390Code E1391Code E1405Code E1406Code E0430Code E0431Code E0433Code E0434Code E0435Code E1392Code K0738Code E0441Code E0442Code E0443Code E0444Code E1399

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