55 Pa. Code § 1123.55 - Oxygen and related equipment
(a) Payment for oxygen and related equipment
will be made only if the patient has had a comprehensive cardiopulmonary
evaluation that resulted in an established diagnosis of the cause of the
respiratory disability. The prescription shall contain the cardiopulmonary
diagnosis.
(b) Prior authorization
is required as specified in §
1101.67 (relating to prior
authorization ) for the first 45 days of use of oxygen and related equipment
unless the physician certifies that the recipient is adequately prepared to use
oxygen equipment and the physical surroundings in the home are suitable for its
use. Prior authorization is not required for continuing use after the initial
45 days providing continued use is prescribed by the practitioner .
(c) Payment will be made only if the
physician includes the flow rate per minute and the specific requirements such
as mask, cannula and nebulizer on the prescription.
(d) A physician shall recertify orders for
oxygen at least every 6 months and recertification shall be kept by the
provider .
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