what are the medicare requirements for supplemental oxygen

Full Answer

Does Medicare cover supplemental oxygen?

Medicare does cover supplemental oxygen therapy if prescribed by your physician. The equipment for patients only needing oxygen nocturnally is a home or stationary concentrator. Patients needing oxygen 24 hours per day will be provided both a home concentrator and a portable solution. A portable solution can be either oxygen tanks or a portable ...

What are the Medicare guidelines for oxygen?

To be covered for oxygen supplies and accessories, you must meet the following requirements:

• Your doctor says you have a severe lung disease or you aren’t getting enough oxygen.
• Your health might improve with oxygen therapy.
• Your arterial blood gas level falls below a certain range.
• Other treatments haven’t improved your condition.
• Your doctor accepts Medicare assignment.

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What is the Medicare criteria for home oxygen?

“As required by the NCD Home Use of Oxygen (240.2), coverage of home oxygen therapy requires that the beneficiary be tested in a ‘chronic stable state’ and that all co-existing diseases or conditions that can cause hypoxia must be treated sufficiently. Moreover, the beneficiary must have a severe lung disease, such as chronic obstructive

Are oximeters covered by Medicare?

Per Medicare guidelines, oximeters (E0445) and replacement probes (A4606) will be considered non-covered because they are monitoring devices that provide information to physicians to assist in managing the member’s treatment.

How do you qualify for supplemental oxygen?

An arterial PO2 at or below 55 mm Hg, or an arterial oxygen saturation at or below 88 percent, for at least 5 minutes taken during sleep for a patient who demonstrates an arterial PO2 at or above 56 mm Hg or an arterial oxygen saturation at or above 89 percent while awake, or.

What is the Medicare requirement for oxygen saturation?

Room air at rest (awake) without oxygen. If this qualifies with an ABG less than or equal to 55 mm Hg or O2 saturation (fingertip pulse oximeter) equal to or less than 88%, no further testing is needed. If the patient does not qualify, then steps B or C below would be required.

What diagnosis qualifies for home oxygen?

Conditions for Which Oxygen Therapy May Be Covered Examples of these symptoms and findings are pulmonary hypertension, recurring congestive heart failure due to chronic cor pulmonale, erythrocytosis, impairment of the cognitive process, nocturnal restlessness, and morning headache.

Is oxygen covered under Medicare Part B?

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. covers the rental of oxygen equipment and accessories as durable medical equipment (DME) that your doctor prescribes for use in your home.

What is the oxygen saturation threshold below which supplemental oxygen would be required?

Hypoxemia (decreased level of oxygen in the blood) is the most readily accepted indication for supplemental oxygenation. Oxygen saturation targets are 92 to 98% in a healthy patient. Values under 90% are considered to be low.

Are pulse oximeters covered by Medicare?

Medicare does not cover pulse oximeters. Some private insurance plans do cover pulse oximetry services. For instance, Aetna's Medicaid plan in Pennsylvania considers pulse oximetry for home use a coverable service under specific diagnostic criteria such as chronic lung disease.

What are the indications for home oxygen use?

IndicationsChronic Obstructive Pulmonary Disease (COPD) LTOT is indicated for patients with chronic obstructive pulmonary disease (COPD) when: ... Interstitial Lung Disease (ILD) ... Pulmonary Hypertension. ... Cystic Fibrosis (CF) ... Advanced Cardiac Failure.

When do you need oxygen at home?

Home oxygen therapy is helpful when your level is 88 percent or less. Some people only need extra oxygen at certain times. For example, your doctor may tell you to use oxygen therapy when you exercise or sleep, or if your blood oxygen is 88 percent or less.

Does pulmonary hypertension qualify for oxygen?

The American College of Cardiology Foundation/American Heart Association pulmonary hypertension treatment guidelines recommend that oxygen therapy be used to maintain arterial blood oxygen saturation of >90% in patients with PAH.

Does Medicare cover oxygen for COPD patients?

Original Medicare Part B covers oxygen and equipment for use at home, although certain conditions apply. Part A covers oxygen therapy during an inpatient stay. If someone has a lung disorder, such as severe chronic obstructive pulmonary disease (COPD), a heart problem, or asthma, they may need oxygen therapy.

Will Medicare pay for the purchase of a portable oxygen concentrator?

If you own your own equipment, Medicare will help pay for oxygen contents and supplies for the delivery of oxygen upon meeting Medicare conditions including doctor recommendation, failing arterial blood gas level range and other alternative measures have failed.

Does using oxygen make your lungs weaker?

Home oxygen therapy is not addictive and it will not weaken your lungs. You will get maximum benefit by using oxygen for the amount of time prescribed by your doctor. There is a range of oxygen equipment available.

How long does Medicare provide oxygen?

If you have Medicare and use oxygen, you’ll rent oxygen equipment from a supplier for 36 months. After 36 months, your supplier must continue to provide oxygen equipment and related supplies for an additional 24 months. Your supplier must provide equipment and supplies for up to a total of 5 years, as long as you have a medical need for oxygen.

How much does Medicare pay for oxygen tanks?

If you use oxygen tanks or cylinders that need delivery of gaseous or liquid oxygen contents, Medicare will continue to pay each month for the delivery of contents after the 36-month rental period, which means that you will pay 20% of the Medicare-approved amount for these deliveries.

What is Part B for medical equipment?

Oxygen equipment & accessories. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. covers the rental of oxygen equipment and accessories as durable medical equipment (DME) that your doctor prescribes for use in your home. Medicare will help pay for oxygen equipment, ...

What is Medicare approved amount?

Medicare-Approved Amount. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. , and the Part B deductible applies.

How long does a supplier own equipment?

The supplier owns the equipment during the entire 5-year period . If your medical need continues past the 5-year period, your supplier no longer has to continue providing your oxygen and oxygen equipment, and you may choose to get replacement equipment from any supplier.

Does Medicare pay for oxygen?

Medicare will help pay for oxygen equipment, contents and supplies for the delivery of oxygen when all of these conditions are met: Your doctor says you have a severe lung disease or you’re not getting enough oxygen. Your health might improve with oxygen therapy.

Does Medicare cover oxygen equipment?

If you meet the conditions above, Medicare oxygen equipment coverage includes: Systems that provide oxygen. Containers that store oxygen. Tubing and related oxygen accessories for the delivery of oxygen and oxygen contents. Medicare may also pay for a humidifier when it's used with your oxygen machine.

How To Pay For A Portable Oxygen Concentrator

Portable oxygen concentrators are great devices for those with a medical need for oxygen who live an active, on-the-go lifestyle. After choosing to buy a portable oxygen concentrator, youll likely have some questions, especially related to how youll pay for the device.

What Equipment And Accessories Are Covered By Medicare

If you meet all the requirements, Medicare Part B will pay for specific equipment needed to provide oxygen therapy in your home.

How Much Does It Cost To Rent An Oxygen Concentrator

Costs can vary significantly depending on what kind of oxygen concentrator you want to rent, what kind of insurance coverage you have and whether or not you meet the criteria to have your rental covered by insurance.

Group I Criteria Include Any Of The Following

An arterial PO2 at or below 55 mm Hg or an arterial oxygen saturation at or below 88 percent taken at rest , or

Overview: Qualifying For Home Oxygen

First, if you want to receive home oxygen treatment youll need to meet the following criteria:

What About Portable Oxygen Concentrators

Unfortunately, Medicare will not pay for a portable oxygen concentrator if you are already using Medicares oxygen rental benefit. The reason for this is that Medicare pays the supplier the same amount whether the supplier gives you a portable tank or a portable concentrator.

Medicare Home Oxygen Lcd Coverage

For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements.

How long does Medicare pay for oxygen?

Medicare will continue paying for the delivery of oxygen contents after your 36-month rental period.

How long does Medicare cover oxygen tank rental?

If you are enrolled in Medicare Part B and your oxygen tank and other equipment is prescribed by a doctor, Medicare should cover costs related to your equipment rental: If you rent oxygen equipment and receive coverage under Medicare, you’ll need to rent the equipment from a supplier for 36 months. After that period concludes, your supplier will ...

How long does an oxygen supply last?

After that period concludes, your supplier will continue providing oxygen equipment and supplies for another 24 months (a total of five years), as long as you have a medical need for oxygen. Your supplier must ensure equipment is in good condition and working order.

Does Medicare cover delivery?

Medicare will likely cover the cost of the contents and supplies needed for delivery if you meet all of the following requirements: Your doctor says you’re not getting enough oxygen or have severe lung disease.

How much does Medicare pay for oxygen?

You must also pay a monthly premium. In 2020, the premium is typically $144.60 — though it may be higher, depending on your income. Once you’ve met your Part B deductible for the year, Medicare will pay for 80 percent of the cost of your home oxygen rental equipment.

Why do we need oxygen at home?

The medical necessity of home oxygen is determined by testing to see whether your condition is causing hypoxemia. Hypoxemia occurs when you have low levels of oxygen in your blood.

What are the different types of oxygen systems?

Several types of oxygen systems exist, including compressed gas, liquid oxygen, and portable oxygen concentrators. Here’s an overview of how each of these systems works: Compressed gas systems. These are stationary oxygen concentrators with 50 feet of tubing that connects to small, prefilled oxygen tanks.

What is the Medicare Part B deductible?

This is the amount of out-of-pocket costs you must pay before Medicare begins to cover approved items and services.

How long does Medicare pay for equipment rental?

The supplier still owns the equipment, but the monthly rental fee ends after 36 months. Even after the rental payments have ended, Medicare will continue paying its share of the supplies needed to use the equipment, such as the delivery of gas or liquid oxygen.

Does Medicare cover portable oxygen concentrators?

These electric units don’t require tanks to be filled and come with only 7 feet of tubing. But it’s important to know that Medicare covers portable oxygen concentrators only in very specific circumstances. Medicare will cover stationary oxygen units for use at home.

Can you use too much oxygen?

You need to work with your doctor to find the right treatment, dosage, and duration for your specific condition. Just as too little oxygen can harm you, too much oxygen can also carry risks . Sometimes, you only need to use oxygen for a short time.

Description Information

Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Transmittal Information

03/1987 - Clarified coverage criteria for home oxygen use including portable and stationary oxygen systems. Effective date 04/13/1987. (TN 13)

What does a physician need to know about oxygen therapy?

To qualify for coverage of the apparatus needed for oxygen fulfillment, your physician must attest to the medical necessity of your equipment, certifying that the severity of your lung disease demands assistance. Additionally, the doctor must state that the oxygen therapy is expected to improve your health. If your arterial blood gas level drops below a set range, your physician may order oxygen equipment once other options have been explored but have been unsuccessful.

How much does Medicare pay for DME?

Once your DME has been approved, Medicare recipients with Original Medicare can expect to pay 20% of the approved amount plus the deductible for Part B. If you have Medicare Advantage or a Medicare supplement plan, otherwise known as Medigap, check with your plan administrator for any additional coverage that may apply.

What is Medicare Part B?

Medicare Part B (Medical Insurance) includes coverage for medically necessary services and supplies, including benefits for durable medical equipment (DME). DME includes a wide range of medical equipment, including oxygen supplies, such as the systems, storage containers, tubing and associated accessories needed to transport the oxygen.

What happens if your blood gas level drops below a set range?

If your arterial blood gas level drops below a set range, your physician may order oxygen equipment once other options have been explored but have been unsuccessful.

Does Medicare cover tank refilled?

When the tanks or cylinders need to be refilled, Medicare monthly payments cover delivery of the contents , but Medicare recipients may continue to be responsible for the 20% portion of the Medicare-authorized amount.

What is the only requirement for oxygen?

The only requirement, of course, is that it provides medical grade oxygen that meets your medical needs. Any of these models could be provided. A patient needing oxygen 24 hours per day will be given both a home or stationary concentrator as just described AND a portable solution.

What equipment is needed for a patient who needs oxygen?

The equipment for patients only needing oxygen nocturnally is a home or stationary concentrator. Patients needing oxygen 24 hours per day will be provided both a home concentrator and a portable solution. A portable solution can be either oxygen tanks or a portable oxygen concentrator. Medicare coverage for supplemental oxygen is via ...

What is Medicare responsible for?

The Medicare provider is responsible for making sure the equipment is in good working order and that it meets the requirements prescribed by your doctor.

Does Medicare cover oxygen?

Medicare coverage for supplemental oxygen is via a monthly rental program where the equipment is provided by a Medicare or Durable Medical Equipment provider. Medica re will never cover the purchase of oxygen therapy equipment. Patients can select their Medicare provider (like you can select your doctor), but a provider is not required ...

Do portable oxygen concentrators need to be specific?

It does not need to be a specific brand, type or solution.

Can you select a provider for Medicare?

Patients can select their Medicare provider (like you can select your doctor), but a provider is not required to provide a specific brand or portable solution. We hope this helps provide you with a few clear facts on Medicare and supplemental oxygen coverage. There are two additional videos on Medicare coverage.

What does a doctor say about supplemental oxygen?

Your doctor provides a prescription saying that you require supplemental oxygen and/or have a severe lung disease. Your medical documentation indicates that you are mobile in your home and would benefit from the use of a portable system. Alternative treatments have failed.

How to qualify for home oxygen therapy?

To qualify for home oxygen therapy, consider taking the following 5 steps: Talk to your doctor about whether you have a qualifying medical condition for getting oxygen at home. This includes a lung condition or other condition that impairs your breathing . You may qualify for home oxygen therapy if you have symptoms and/or findings related ...

How long can you rent oxygen with Inogen One?

You will pay 20% of the Medicare approved amount, with the Part B deductible still applying. You will be able to rent your oxygen equipment for 36 months, after which time your supplier must continue to provide oxygen equipment ...

What is the oxygen saturation level for home oxygen therapy?

Typically, to qualify for home oxygen therapy, you must have either: An arterial blood gas (PaO2) at or below 55 mm Hg or an oxygen saturation at or below 88%, taken at rest (awake) An PaO2 at or below 55 mm Hg, or an oxygen saturation at or below 88%, taken during sleep for a specified duration for a patient who demonstrates a PaO2 at or ...

What to do if oxygen is not clear on prescription?

If you are not clear on your prescription, contact your doctor’s office so they can clarify the information for you before you look for your ideal oxygen delivery device .

How long can you rent oxygen?

You will be able to rent your oxygen equipment for 36 months, after which time your supplier must continue to provide oxygen equipment and related supplies for an additional 24 months, and up to 5 years, as long as you have a medical need for oxygen. Even with state of the art equipment like the Inogen One, Medicare offers rental coverage ...

What tests are done to determine if you need oxygen?

If you or your doctor suspect that you would benefit from oxygen therapy, you will complete a number of tests, including an arterial blood gas study and pulse oximetry, to demonstrate that your blood oxygen levels indicate the need for oxygen therapy. If your measurements qualify you for home oxygen, you will receive a prescription ...