DMEPOS Clinical Trials and Demonstrations (Rev. 2993, Upon Implementation of ICD- 10)

by  Jared Staheli
June 17th, 2015

The definition of the QR modifier is “item or service has been provided in a Medicare specified study.” When this modifier is attached to a HCPCS code, it generally means the service is part of a CMS related clinical trial, demonstration or study.

The DME MACs shall recognize the “QR” modifier when associated with an oxygen home therapy clinical trial identified by CMS and sponsored by the National Heart, Lung & Blood Institute. DME MACs shall pay these claims if the patient’s arterial oxygen partial measurements are from 56 to 65 mmHg, or whose oxygen saturation is at or above 89%.

The definition of condition code 30 is “qualified clinical trial.” When this condition code is reported on a claim, it generally means the service is part of a CMS related clinical trial, demonstration or study.

The A/B MACs (HHH) shall recognize condition code 30, accompanied by ICD-9-CM diagnosis code V70.7 or ICD-10 diagnosis code Z00.6, as applicable, in the second diagnosis code position, when associated with an oxygen home therapy clinical trial identified by CMS and sponsored by the National Heart, Lung & Blood Institute. A/B MACs (HHH) shall pay these claims if the patient’s arterial oxygen partial measurements are from 56 to 65 mmHg, or whose oxygen saturation is at or above 89%.

References:

DMEPOS Clinical Trials and Demonstrations (Rev. 2993, Upon Implementation of ICD- 10). (2015, June 17). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/dmepos-clinical-trials-and-demonstrations-26697.html

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