Information for prescribers - DME & Oxygen

Page Links - Oxygen  CPAP / BiPAP  Wheelchairs  Walkers  Hospital Beds  Nebulizers  Scooters  Diabetic Shoes

OXYGEN information

The following is qualifying information for Medicare and most insurance company coverage.  Click on the picture to the right to download a page with Oxygen qualifying information.

1. An arterial PO2 at or below 55 mmHg or an arterial oxygen saturation at or

below 88 percent taken at rest (awake), or

2. An arterial PO2 at or below 55 mmHg, or an arterial oxygen saturation at or below 88 percent, taken during sleep for a patient who demonstrates an arterial PO2 at or above 56 mmHg or an arterial oxygen saturation at or above 89% while awake, or

3. A decrease in arterial PO2 more than 10 mmHg, or a decrease in arterial oxygen saturation more than 5 percent taken during sleep associated with symptoms or signs reasonably attributable to hypoxemia (e.g., corpulmonale, “P” pulmonale on EKG, documented pulmonary hypertension and erythrocytosis), or

4. An arterial PO2 at or below 55 mmHg or an arterial oxygen saturation at or below 88 percent, taken during exercise for a patient who demonstrates an arterial PO2 at or above 56 mmHg or an arterial oxygen saturation at or above 89 percent during the day while at rest. In this case, oxygen is provided during exercise if it is documented that the use of oxygen improves the hypoxemia that was demonstrated during exercise when the patient was breathing room air.

5. Dependent edema suggesting congestive heart failure, or

6. Pulmonary hypertension or cor pulmonale, determined by measurement of pulmonary artery pressure, gated blood pool scan, echocardiogram, or “P” pulmonale on EKG (P wave greater than 3 mm in standard leads II, III, or AVF), or

7. Erythrocythemia with a hematocrit greater than 56 percent.

If one or more of the coverage conditions specified above are not met, the oxygen therapy will be considered not medically necessary. Oxygen therapy will also be considered not medically necessary if any of the following conditions are present:

a. Angina pectoris in the absence of hypoxemia. This condition is generally not the result of low oxygen level in the blood and there are other preferred treatments.

b. Dyspnea without cor pulmonale or evidence of hypoxemia.

c. Severe peripheral vascular disease resulting in clinically evident desaturation in one or more extremities but in the absence of systemic hypoxemia. There is not sufficient medical evidence that increased PO2 will improve the oxygenation of tissues with impaired circulation.

d. Terminal illnesses that do not affect the respiratory system. The qualifying blood gas study must be performed by a physician, qualified Medicaid provider or qualified laboratory. The qualifying blood gas study may be performed while the patient is on oxygen as long as the reported blood gas values meet the coverage criteria.

Overnight oximetry testing: <CLICK HERE> to download an order for overnight oximetry testing.  Testing information is uploaded to IDS (Instant Diagnostic Systems) and that information can be used to qualify a patient for insurance coverage of their oxygen therapy equipment.

Note: Maier Family Pharmacy has 24/7 Oxygen service. Setups can be done the same day as O2 is ordered and all setups include patient training and follow-ups by our RT.  Maier Family Pharmacy is franchised with ConvaCare Services, a subdivision of Lincare, for our Oxygen services.  This enables us to have nation-wide Oxygen coverage for patients who travel or vacation in other parts of the country.  Patient care is provided by the Home Healthcare staff of Maier Family Pharmacy and physicians are notified if patient compliance isn't being met.

CPAP / BiPAP information

How is obstructive sleep apnea diagnosed?

OSA must be diagnosed by an attended, facility based polysomnogram, and the patient must meet one of the following Apnea-Hypopnea Index (AHI) criteria:

1. AHI >– 15 events per hour

2. AHI from 5 to 14 events per hour with documented symptoms of: A) excessive daytime sleepiness, impaired cognition, mood disorders or insomnia; or B) documented hypertension, ischemic heart disease or history of stroke.

What is Medicare’s definition of AHI?

The AHI is defined as the average number of episodes of apnea and hypopnea per hour, and must be based on a minimum of two hours of recording time without the use of a positive airway pressure device, reported by polysomnogram.

Apnea is defined as the cessation of airflow for at least 10 seconds as documented on a polysomnogram. Hypopnea is defined as an abnormal respiratory event lasting at least 10 seconds and associated with at least a 30% reduction in thoracoabdominal movement or airflow as compared to baseline, and with at least a 4% decrease in oxygen saturation.

CPAP and BiPAP systems and supplies can only be dispensed with a prescription.  Maier Family Pharmacy requires a copy of the patient's split sleep study for all new CPAP orders.  The sleep study is also needed for ongoing billing of patient supplies like masks, tubing and filters.  CPAP prescriptions are generally written by the patient's physician after a recommendation from a certified sleep lab therapist or technician.  If a patient is requiring a new mask, tubing or filters, please write a prescription for Mask and supplies. 

Please fax all sleep study information along with a prescription to: 712-881-1206.

Note: In most cases, CPAP setups require 2-4 days to order the correct mask for the patient.  The patient will be contacted for a setup time and date from our respiratory therapist.

Maier Family Pharmacy does not perform sleep studies.  Physicians or patients can order sleep studies through the area hospital sleep labs or by an independent firm. Qualifying information must include the AHI#

WHEELCHAIR information

Wheelchairs no longer require a CMN for billing purposes.

1. When writing a prescription for a wheelchair, indicate the patient's weight and height.  If the patient has a larger than average hip measurement, include this on the prescription.

2. Include a diagnosis (need) for the wheelchair.

3. Indicate the length of time the patient will need the equipment.

4. Indicate any special modifications needed for the equipment.

    (example: Leg Rests, Foot Rests, etc.) 

WALKER information

When writing a prescription for a walker, indicate the type of walker the patient needs.  If the patient requires a rolling walker (like the picture to the right), write a prescription for a rolling walker with seat and brakes.  If the patient requires a standard folding walker, write the prescription for a standard walker.

Note: Patients with very limited hand strength may have a hard time operating the brakes on a rollator.

Include the patient's diagnosis, length of need, height and weight on the prescription.

Maier Family Pharmacy stocks standard folding walkers, deluxe and standard InvaCare Rollators and jr.-sized walkers for children or short adults.  Patients can also find accessories like trays, bags, wheels and replacement tips and skis at the pharmacy.

HOSPITAL BED information

Maier Family Pharmacy stocks standard semi-electric and full-electric  InvaCare & Medline hospital beds.  Head and foot elevations are controlled by the patient with a remote control.  The overall height of the bed is adjustable with a crank on the end of the bed on semi-electric beds and on the remote for full electric beds..  All beds come with a standard twin size mattress w/cover and bed rails.  Beds are usually delivered the same day as the prescription is received unless otherwise specified by the patient or patient's family.

When writing a prescription for a hospital bed include the following:

1. Patient's height and weight

2. Diagnosis

3. Length of need

NEBULIZER information

Nebulizer compressors and nebulizer breathing kits require a prescription.  Maier Family Pharmacy requires a separate prescription from the nebulizer solution to dispense a compressor or neb. kit. When writing a prescription for a nebulizer include the following information:

1. Patient's name

2. Diagnosis

3. Length of need. (If the patient has COPD and/or require multiple rentals or treatments, use 99 for length of need to help insure a purchase or extended rental period from insurance company).

Note: Patients can purchase a nebulizer if they have a valid prescription.  Replacement neb kits also require a prescription.

DIABETIC SHOES information

Diabetic shoes are covered by Medicare and some insurance policies.  With Medicare and a supplement plan, there is little-to-no cost for the patient.  Diabetic shoes require a physician's order to be covered by Medicare.  Click Here to download an order form and brochure that explains the benefits of Diabetic footwear.

Maier Family Pharmacy carries Dr. Comfort and Orthofeet diabetic shoes.  (Click on the brand name to see a selection of the shoes carried by MFP)  Insoles for the diabetic shoes can be either heat-moldable or custom-made from a mold of the patient's foot.  Custom-insoles are made at either the Ped-Lite lab in Indiana, or the Dr. Comfort lab in Wisconsin..  MFP has the patient step into a box containing a soft biofoam.  This impression is used to create a cast mold of the patient's foot by which the orthotic is created at the lab.

Diabetic shoes can also be privately purchased without a prescription for patients who suffer from foot problems. 

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In an effort to save time, we ask that prescribers include the following information on their prescriptions when writing an order for medical equipment.

       TYPE OF EQUIPMENT BEING PRESCRIBED

       DIAGNOSIS OR DIAGNOSIS CODE

       LENGTH OF NEED

       PATIENT WEIGHT & HEIGHT IF NON-STANDARD EQUIPMENT BEING ORDERED*

* If a patient's weight is over 250lbs., please include height & weight on prescription.

By including this information on the prescription, additional paperwork can be avoided.

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Diabetic/Therapeutic Shoes

At Maier Family Pharmacy, we take diabetes care very seriously.  We offer the latest products and services to enhance the health and well-being of our diabetic patients.  Test strips, meters, compression hosiery and an expanded line of diabetic shoes are all available.  Maier Family Pharmacy has the area's largest selection of diabetic footwear! Visit the Diabetic Shoes page for more information and to access online shoe catalogs.  *We make shoe fitting house-calls call us for an appt. 712-881-1033 or 1-800-383-4743.

Diabetic Socks