How does portable oxygen work on NEMT trips?
Portable oxygen on a NEMT trip means the rider brings and manages their own oxygen, usually a small cylinder or a portable concentrator. Federal ADA transportation rules bar covered providers from prohibiting riders with disabilities from traveling with portable oxygen. The driver does not set up or adjust it. The rider must be stable and able to self-monitor, and the tank must be secured.
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What portable oxygen means on a trip
Portable oxygen is the rider’s own oxygen supply, carried on the ride. It is usually a small compressed gas cylinder or a battery-powered portable concentrator. The rider, or their supplier, owns and runs the equipment. The NEMT provider moves the rider and keeps the equipment secure.
This is different from oxygen given by an ambulance crew. An ambulance can start, adjust, and monitor oxygen. A NEMT driver cannot.
The federal rule
The ADA transportation rules cover this directly. 49 CFR 37.167(h) says a covered transportation entity shall not prohibit a person with a disability from traveling with a respirator or portable oxygen supply. It adds that this must be consistent with DOT’s hazardous materials rules. The section applies to both public and private entities.
Who can ride with oxygen, and in what vehicle
Oxygen does not set the vehicle level by itself. The rider’s mobility does, as long as the rider can manage the oxygen. Medi-Cal’s manual spells out the split:
| Rider | Vehicle |
|---|---|
| Chronic condition, uses oxygen, needs no monitoring, clinically stable, can self-monitor the oxygen system | Wheelchair van or litter van |
| Recently placed on oxygen | Ambulance |
| Chronic condition that needs monitoring while on oxygen | Ambulance |
Virginia’s rules point the same way. A stretcher van may carry a rider using self-administered oxygen if the tank is secured safely. Riders who need oxygen therapy beyond self-administered oxygen are not eligible for stretcher van service. Virginia also asks members to tell the call center about oxygen when they book, so the right vehicle is sent. The level of service on the trip should reflect that note.
Securing oxygen in the vehicle
An unsecured cylinder can break free and hurt someone in a crash. Secure it before the vehicle moves:
- Stretcher vans. Virginia requires self-administered oxygen to be secured to AMD Standard 003, the Oxygen Tank Retention System Test.
- Wheelchairs. RESNA WC19 does not directly cover add-on equipment such as oxygen tanks. It does require wheelchair makers to warn users to remove auxiliary equipment and secure it separately in the vehicle whenever possible. Otherwise it must be fastened to the chair so it cannot break free.
- Other equipment. Some stair chairs and cots offer oxygen bottle holders. Stryker lists one as an option on its Stair-PRO stair chair and its MX-PRO Bariatric cot.
Keep every flame and cigarette away from the rider. Virginia bans smoking, vaping, and e-cigarettes in NEMT vehicles at all times, and requires a posted no-smoking sign in every vehicle.
Booking checklist
- What type of oxygen is it: a cylinder or a portable concentrator?
- Does the rider have enough supply or battery for the round trip plus any wait?
- Can the rider manage the oxygen with no help from the driver?
- How will the tank be secured: vehicle holder, chair bracket, or cot holder?
- What is the mobility level: ambulatory, wheelchair, or stretcher?
How oxygen affects billing
There is no NEMT oxygen code. The trip bills under its mode, such as A0130 or T2005. HCPCS A0422 is an ambulance code for oxygen in a life-sustaining situation. Medi-Cal, for one, lists A0422 in its wheelchair and litter van table, so read your fee schedule.
In HealthRide, vehicles can be marked as oxygen equipped, and oxygen needs are checked on every assignment. See Fleet.
Frequently asked questions
- Can the driver help with the rider's oxygen?
- Not with the oxygen itself. Virginia's NEMT handbook says drivers cannot assist with oxygen unless the rider is traveling by ambulance. Drivers can secure the tank or concentrator in the vehicle. A rider who needs someone to manage or adjust oxygen during the ride needs an ambulance.
- Which vehicle should carry a rider on oxygen?
- The one that fits the rider's mobility, as long as they manage the oxygen themselves. Medi-Cal sends chronic oxygen users who need no monitoring by wheelchair van or litter van when they are clinically stable and can self-monitor. Riders recently placed on oxygen, or who need monitoring, go by ambulance.
- Is there a billing code for oxygen on NEMT trips?
- Not a NEMT-specific one. HCPCS A0422 covers ambulance oxygen and supplies in a life-sustaining situation. Medi-Cal does list A0422 in its wheelchair and litter van rate table at $9.98 (page updated September 2023), so check your own fee schedule before you assume either way.
