Oxygen 36-Month Cap Refresher
What this page is for
Use this when handling Medicare oxygen rentals approaching the cap, switching providers, determining billing responsibility, or resolving questions on the 36-month and 60-month cycles.
1. What the 36-Month Cap Means
Medicare pays 36 monthly rental payments for oxygen equipment.
After month 36:
- The supplier is responsible for furnishing and maintaining the oxygen equipment at no cost to the beneficiary.
- Monthly rental billing stops.
- Medicare continues to pay for oxygen contents (E0443, E0441, E0442) if medically necessary.
- The beneficiary remains in a 60-month capped rental cycle.
2. Supplier Responsibilities After Month 36
After the cap is reached, the supplier must:
- Maintain and service the concentrator
- Replace broken equipment (unless misuse)
- Provide backup tanks if medically needed
- Respond to service calls
- Not bill Medicare for rental or maintenance unless in a rare M&S case
In short: Medicare stops paying, but you don’t stop working.
3. What You Can Still Bill After Month 36
✔ Portable oxygen contents
✔ Liquid contents
✔ Backup tanks (if justified)
✔ Accessories only in limited cases where not included in the original rental
4. What You Cannot Bill
❌ Rental items (E1390, E0431, E0434, etc.)
❌ Concentrator replacements (unless 60+ month cycle reset)
❌ Routine maintenance
❌ Patient pickup / delivery fees
❌ Restarts of capped rental
5. When the 60-Month Cycle Resets
A new 60-month cycle begins only when:
- The full 60 months have passed, and
- The patient still qualifies medically, and
- A new initial claim is submitted
This is the only time rental billing may start over.
6. Patient Transfers
A. Transfer BEFORE Month 36
- The new supplier takes over remaining rental months.
- Rental continues from whatever month the previous supplier left off.
- Requires:
- SWO
- Qualifying documentation
- Proof of continued need
B. Transfer AFTER Month 36
- The original supplier remains responsible for furnishing equipment through month 60.
- A new supplier cannot bill rental.
- A new supplier can accept the patient, but must do so without rental payment.
- Documentation proving release from responsibility is extremely rare.
Bottom line:
If the patient is capped, the responsibility follows the equipment, not the supplier.
7. Maintenance & Servicing (M&S)
M&S billing is rare. It applies only when:
- The equipment is beyond useful life after the 5-year cycle, and
- A home visit is medically required
In almost all other situations, M&S billing is not allowed.
8. Documentation Needed
- SWO
- Medical necessity confirming ongoing need
- Proof of patient use
- Prior rental history (HETS lookup or internal records)
- Contents necessity (if billing contents)
Lack of ongoing need documentation can cause contents denial.
9. Quick Reference Table
| Scenario | Billable? | Notes |
|---|---|---|
| Months 1–36 | ✔ Rental | Standard rental cycle |
| Month 36+ | ❌ Rental | Supplier responsibility starts |
| Portable contents | ✔ | If medically necessary |
| Transfer <36 months | ✔ | Continue remaining rental months |
| Transfer >36 months | ❌ Rental | New supplier inherits responsibility |
| Replacement <60 months | ❌ | No reset |
| Replacement 60+ months | ✔ | New cycle begins |
10. Staff TL;DR
- 36 months = no more rental billing.
- Supplier must still service equipment until month 60.
- Contents may still be billable.
- Transfers after month 36 = you take responsibility, not rental revenue.
- New rental only after the full 60-month cycle ends.