Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1123 - MEDICAL SUPPLIES
PAYMENT FOR MEDICAL SUPPLIES
Section 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.