Temporary Increase: COVID-19 Durable Medical Equipment Oxygen and Respiratory Rates

Originally published May 10, 2021
Updated September 8, 2021

Effective for dates of service on or after March 1, 2020 and updated effective January 1, 2021, Durable Medical Equipment (DME) Oxygen and Respiratory rates are temporarily increased due to the ongoing coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE).

Following the declaration of the PHE and national emergency in the United States, the Centers for Medicare & Medicaid Services approved Disaster Relief State Plan Amendment 21-0016 authorizing the Department of Health Care Services (DHCS) to increase the DME Oxygen and Respiratory rates equivalent to 100 percent of the Medicare rate, retroactively effective from March 1, 2020, to the end of the PHE. In addition, the DME Oxygen and Respiratory codes are exempt from the 10 percent payment reduction in Welfare and Institutions Code (W&I Code) section 14105.192, as described in Attachment 4.19-B, page 3.3, paragraph 13 of the State Plan.

DHCS updated the DME Oxygen and Respiratory rates effective for dates of service on or after March 1, 2020 and effective January 1, 2021, based on the corresponding Medicare rate as provided in the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fee Schedule. The updated rates for DME Oxygen and Respiratory services were implemented on June  21, 2021 and the rates for an additional 16 DME Oxygen and Respiratory services are expected to implement on September 27, 2021.

Refer to the Medi-Cal Rates page for more information on rate updates.

An Erroneous Payment Correction (EPC) will be implemented to reprocess claims with dates of service on or after the effective date of this billing policy that were appropriately submitted based on the guidance published in this article, but were paid based on the previously published rate.