what qualifies you for oxygen

What medical conditions require oxygen?

• chronic obstructive pulmonary disease (COPD)
• pneumonia.
• asthma.
• bronchopulmonary dysplasia, underdeveloped lungs in newborns.
• heart failure.
• cystic fibrosis.
• sleep apnea.
• lung disease.

Full Answer

What is a qualifying diagnosis for oxygen?

Mar 21, 2022 · 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) Many beneficiaries with non-chronic lung diseases, such as pneumonia, do seek assistance breathing with oxygen but these beneficiaries are not covered.

What are the Medicare guidelines for oxygen?

chronic stable state conditions (nocturnal, stationary oxygen qualification only): • Nocturnal oximetry, for the purpose of oxygen reimbursement qualification, may only be performed after optimal positive airway pressure settings have been determined and the beneficiary is using the positive airway pressure device at those settings.

What are the qualifications for oxygen?

What qualifies you for oxygen? 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) Click to see full answer. Just so, does hypoxemia qualify for oxygen?

What are the requirements for home oxygen?

Nov 09, 2021 · To qualify for home oxygen therapy, in addition to conversing with your doctor and getting your medical records, you must participate in a study that proves your need for supplemental oxygen. This involves two tests, an arterial blood gas (ABG) and a …

What qualifies a patient for oxygen?

Qualification for receiving oxygen at rest If your patient has an arterial oxygen saturation SaO2(2 is subscript)≤88% or partial pressure of oxygen Po2(2 is subscript)≤55 mm Hg at rest, no further testing is required.

What diagnosis qualifies for home oxygen?

Short term supplemental home oxygen therapy is medically necessary for treatment of hypoxemia-related symptoms with qualifying laboratory values (see Note below) associated with acute conditions including, but not limited to any of the following: Bronchiolitis; or. Chronic obstructive pulmonary disease exacerbation; or.

How do you measure oxygen in your home?

Recording of your oxygen levels, by placing a small probe on to one of your fingers. A blood gas test, that involves taking a small sample of blood from your ear lobe. You may be asked to perform a walking test, which allows us to understand if your oxygen levels are lower when you are walking.

Does pneumonia qualify for home oxygen?

Many beneficiaries with non-chronic lung diseases, such as pneumonia, do seek assistance breathing with oxygen but these beneficiaries are not covered. Significant hypoxemia (oxygen deprivation, shortness of breath) may only be demonstrated to Medicare by oxygen level testing satisfying strict requirements.

What Is Home Oxygen Therapy?

Simply put, home oxygen therapy is supplemental oxygen for home use. The air you normally breathe contains around 21 percent oxygen, and supplemental oxygen increases this ratio significantly.

In-Person Evaluation

Your first step toward qualification is to speak with your doctor. You can either open a dialogue with your primary care physician, a doctor of osteopathy, a nurse practitioner, a clinical nurse specialist, or a physician assistant.

Procure Medical Records

Your next move is to obtain medical records that document a condition that requires home oxygen therapy. This record should include your diagnosis, the duration of your condition, whether your condition is worsening or improving, and your prognosis. If there have been other therapeutic interventions, your records should show the results.

Take an Oxygen Qualification Test

To qualify for home oxygen therapy, in addition to conversing with your doctor and getting your medical records, you must participate in a study that proves your need for supplemental oxygen. This involves two tests, an arterial blood gas (ABG) and a pulse oximetry test.

Sleep Studies

You can also participate in sleep studies to learn more about your breathing difficulties. If you have trouble breathing in your sleep, you may want to consider participating and adding the results to your medical records.

Obtain a Prescription

Once you’ve done all the above, it’s time to obtain a prescription from your doctor. This will include a diagnosis of your condition that requires the use of supplemental oxygen, and it will also describe the oxygen flow rate (in liters per minute).

Portable Oxygen Qualifications

Acquiring portable oxygen therapy for your home involves all the same qualifications, but you must also ensure your medical records show your mobility within your home. If you’re hoping to stay active and travel, obtaining a portable oxygen concentrator will make everything a bit simpler.

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.

What is chronic obstructive pulmonary disease?

As you probably know already, this is Chronic Obstructive Pulmonary Disease. It may consist of emphysema, chronic bronchitis, or both. This must be documented in your medical records. There are also other lung diseases that may qualify you, such as heart failure, lung cancer, cystic fibrosis, or pulmonary fibrosis.

Do you need oxygen for COPD?

So, many people with COPD do not need supplemental oxygen. This may be true even if you experience shortness of breath. Yes, you can be short of breath while continuing to have normal oxygen levels. However, some people with COPD may benefit from supplemental oxygen. If this describes you, now you know what tests your doctor may order to see ...

Does Medicare pay for portable oxygen concentrators?

However, some will supply portable oxygen concentrators. Most people allow Medicare to pay for all their home oxygen needs. However, if you are willing to pay, your equipment options are unlimited. There are some really nice portable oxygen devices for those who are willing to pay.

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)