DMEPOS Clinical Trials and Demonstrations

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%.

 Payment for Parenteral and Enteral Nutrition (PEN) Items and Services

Payment for PEN items and services is made in a lump sum for nutrients and supplies that are purchased and on a monthly basis for equipment that is rented.