Local Coverage Determination · DME MAC
L33797
Oxygen and Oxygen Equipment
Version 50. CMS effective date 04/01/2023. CMS updated 04/14/2023. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section 240.2, 240.2.1,240.2.2, 270.4
Coverage indication
The Centers for Medicare and Medicaid Services codifies nationally covered and non-covered indications for home oxygen and oxygen equipment in section 240.2 of the Medicare National Coverage Determination Manual under the durable medical equipment benefit (DME) and section 1862(a)(1)(A) of the Social Security Act for beneficiaries. In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. Home oxygen and oxygen equipment is covered only when both the "reasonable and necessary" criteria defined by NCD 240.2, and the statutory documentation and payment rules discussed in the LCD-related Policy Article (A52514) are met. Refer to the LCD-related Policy Article for additional information on statutory payment policy requirements.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A52514 · Oxygen and Oxygen Equipment - Policy Article
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A58247 · Response to Comments: Oxygen and Oxygen Equipment - DL33797
Related NCDs
- NCD 240.2 · Home Use of Oxygen (version 2)
- NCD 240.2.1 · Home Use of Oxygen in Approved Clinical Trials (version 1)
- NCD 270.4 · Treatment of Decubitus Ulcers (version 1)
- NCD 280.1 · Durable Medical Equipment Reference List (version 4)
HCPCS codes on this LCD
38 other Level II codes are on the LCD and are not given a page in this set: E0424, E0425, E0430, E0431, E0433, E0434, E0435, E0439, E0440, E0441, E0442, E0443, E0444, E0445, E0446, E0447, E1391, E1392, E1405, E1406, A4606, A4608, A4615, A4616, A4617, A4619, A4620, A7525, E0455, E0555, E0580, E1352, E1353, E1354, E1355, E1356, E1357, E1358.
Questions
What does LCD L33797 cover?
L33797 is Oxygen and Oxygen Equipment. It is a current final DME MAC local coverage determination, version 50.
Where is the CMS source for L33797?
The Medicare Coverage Database page for LCD L33797 version 50.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=E1390&as_of=2024-01-15&npi=1234567890&state=UT"