## Definition
The Healthcare Common Procedure Coding System (HCPCS) code E1355 refers to an *oxygen accessory* designed for use with durable medical equipment. Specifically, it pertains to a stand or wheeled cart that is used to facilitate the mobility of oxygen systems. This code was established for billing purposes to document the provision of these accessories by healthcare providers.
The E1355 code falls under Level II of the HCPCS codes, which correspond to products, supplies, and services not included in Current Procedural Terminology codes. It is typically used in the context of claims submitted to Medicare, Medicaid, and some commercial insurance providers for patients requiring oxygen therapy.
## Clinical Context
In a clinical setting, the E1355-covered stand or wheeled cart is essential for ensuring that patients who require oxygen therapy have the flexibility to move their oxygen delivery system. These accessories are integral parts of a patient’s home oxygen therapy equipment. Healthcare providers frequently prescribe them for patients who have limited mobility or who require oxygen support in various rooms of the home.
The use of a wheeled cart allows patients to transport their oxygen system easily, thereby contributing to enhanced quality of life. Oxygen therapy patients, particularly those with chronic obstructive pulmonary disease (COPD), interstitial lung disease, or other chronic respiratory conditions, benefit from oxygen accessories to maintain optimal levels of independence.
## Common Modifiers
Similar to other HCPCS codes, E1355 may frequently be reported with specific modifiers to provide additional information about the claim. Modifiers such as *KH* may be used to denote the initial claim for the stand or wheeled cart as part of the patient’s primary oxygen equipment setup. This modifier is typically used when the equipment is first set up in the patient’s home.
In contrast, a modifier like *RR* may indicate that the item is rented, as oxygen equipment and accessories can often be provided under rental agreements rather than a single purchase. Modifiers allow for the clarification of whether the equipment is new, rented, or being replaced, which aids in adjudicating claims fairly and promptly.
## Documentation Requirements
When billing for HCPCS code E1355, healthcare providers must ensure that documentation fully supports the medical necessity of the item. Medical records should clearly detail the patient’s need for home oxygen therapy, including the diagnosis that necessitates oxygen therapy.
Adequate documentation includes the physician’s order specifying the need for a stand or wheeled cart to facilitate the mobility of the oxygen system. Additionally, documentation must indicate that the patient retains an active need for oxygen therapy, as third-party payers will require verification of the ongoing requirement for these accessories.
## Common Denial Reasons
Denials for HCPCS code E1355 can occur for numerous reasons, including insufficient medical necessity or lack of supporting documentation. A frequent reason for denial is the absence of a valid physician’s prescription specifying the need for a stand or wheeled cart as part of the patient’s oxygen therapy. Such prescriptions must be updated regularly to reflect the ongoing need for oxygen.
Another common reason for denial is the failure to correctly apply the necessary modifiers, particularly when the equipment is on a rental agreement. Failure to submit claims with the correct rental modifier, if applicable, can result in the claim being denied or returned for correction, delaying payment.
## Special Considerations for Commercial Insurers
While HCPCS code E1355 is commonly used in the context of Medicare and Medicaid, providers must be keenly aware of variances in how commercial insurers cover oxygen equipment and accessories. Commercial insurance providers may have differing coverage guidelines, and the criteria for approval may be more stringent. Providers should always review individual payer policies prior to submitting claims involving this code.
It is also important to note that some commercial insurers may impose quantity limits on accessories such as stands or wheeled carts. Additionally, commercial insurers may stipulate durability expectations and prefer that certain codes be bundled together with other components of oxygen systems, rather than billed separately.
## Similar Codes
Several HCPCS codes bear similarity to E1355, focusing on oxygen-related accessories. For example, **E0431** pertains to a portable gaseous oxygen system, which is often used with a wheeled cart. While E0431 covers the oxygen system and E1355 covers its mobility accessory, these codes can sometimes appear in concert in a provider’s claims.
Another related code is **E1353**, which specifies a *regulator* used in oxygen delivery systems. Like E1355, this code is confined to accessories that enhance the function of home oxygen equipment. Cross-referencing these codes ensures that billing practices correctly assign all components of the oxygen system to their respective codes.