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Medicare rules for oxygen - Printable Version

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Medicare rules for oxygen - HalfAsleep - 09-14-2017

Education needed on topic of oxygen

Walla Walla wrote this on another thread: Under Medicare rules you qualify for Oxygen at night. 

This begged questions...

What are the qualifications for oxygen? How would a person know? How can you tell on Sleepyhead printouts that you can qualify for oxygen? How can you tell whether not getting enough O2 is because there's not enough available, versus "the supply is limited because of apneas"?

And anything else you have to say about this general issue....

PS I'm awaiting my CPAP, but believe in knowing whys and wherefors....


RE: Medicare rules for oxygen - OpalRose - 09-14-2017

I believe the procedure would be for your Doctor to determine if oxygen therapy is needed.  
If your doctor thought is was necessary, he could submit that information to Medicare for determination.

Usually, once a person is on cpap therapy, their oxygen levels don't drop at night, unless there are other medical issues going on.

The place to start is have a conversation with your doctor after he has reviewed your overnight sleep study.


RE: Medicare rules for oxygen - Walla Walla - 09-14-2017

I'll answer what I can. This only applies to Medicare. If your oxygen level drops below 88% for 5 or more minutes (non continuous) during the night you qualify for supplemental oxygen at night. You must be measured by a certified third party approved by Medicare. To monitor your oxygen with sleepyhead you need to buy a recording oximeter which you can download into sleepyhead the next morning. As far as CPAP I haven't looked it up in a while I'll try to do that. You could also do that at the Medicare web site.


RE: Medicare rules for oxygen - OpalRose - 09-14-2017

May I suggest if you are going to use a "Medicare Rule", please post a link.


RE: Medicare rules for oxygen - Walla Walla - 09-14-2017

This is not from Medicare but does explain it well. https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/UnitedHealthcare%20Medicare%20Coverage/Oxygen_Home_Use_UHCMA_CS.pdf

That's all I have and with that I wish everyone good luck.


RE: Medicare rules for oxygen - HalfAsleep - 09-14-2017

(09-14-2017, 06:21 PM)Walla Walla Wrote: This is not from Medicare but does explain it well.  https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/UnitedHealthcare%20Medicare%20Coverage/Oxygen_Home_Use_UHCMA_CS.pdf

That's all I have and with that I wish everyone good luck.

Your reference gave me an idea how to find the Medicare specs. Here they are for everyone:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Home-Oxygen-Therapy-Text-Only.pdf

As I read one basic criteria, oxygen would be supplied if your O2 was below 88% for more than 5 minutes while sleeping.


RE: Medicare rules for oxygen - E.W. - 09-14-2017

During my sleep study 10 years ago it was found I would need cpap and oxygen. After a few
years I got tired of the copays for the oxygen concentrator so bought one out of pocket. A few
months ago my concentrator started to act up. To get a new perscription for one I had to have
a new sleep study the rational behind that was perhaps if my cpap settings were tweaked I wouldn't
require oxygen. Well I am waiting on the results of my new sleep study I had done last week.