Medicare Coverage

(A) When Medicare-covered oxygen and respiratory therapy equipment or services are furnished to a recipient who receives Medicare Part B benefits, the rate of payment is always based on the Medicare amount approved. The Division’s payment for such services is limited to the coinsurance and deductible amounts. The provider must submit claims for services furnished to recipients receiving Medicare benefits in accordance with the instructions in Subchapter 5 of the Oxygen and Respiratory Therapy Equipment Manual. (B) Prior authorization from the Division is not required for Medicare-covered services that are furnished to recipients who receive Medicare Part B benefits. (C) When Medicare Part B, or any other primary insurer, denies services or considers services not covered, the provider must obtain prior authorization in accordance with 130 CMR 427.409 through 427.411.