[Treatment] FYI: Home Oxygen Therapy Medicare Coverage Checklist

[Gideon]

I have heard many different requirements for Oxygen while under CPAP with Sleep Apnea, I did some digging.

the short story is 
Medicare says "≤ 88% for a total of 5 minutes" (which need not be continuous)
which is a much shorter period of time than is typically thrown around.


https://www.nwrespiratory.com/uploads/do...46347a.pdf

5. Obstructive Sleep Apnea (OSA) Diagnosis Requirements
 If a patient with a chronic lung disease has also been diagnosed with obstructive sleep apnea (OSA), the
test must be performed during the titration portion of a facility-based polysomnogram.
 Optimal treatment of OSA with the PAP device must be achieved.
 Titration must be conducted over a minimum of two (2) hours.
 During the titration phase, the patient continues to remain hypoxic (≤ 88% for a total of 5 minutes or
more); and
o AHI/RDI reduced to ≤ 10 per hour; or
o If AHI/RDI was ≤ 10 per hour, titration demonstrates further reduction.

https://www.cms.gov/medicare-coverage-da...CDId=33718

Coverage of home oxygen therapy requires that the beneficiary be tested in the “chronic stable state.” Chronic stable state is a requirement of the National Coverage Determination (CMS Pub. 100-03, Section 240.2) and is one of the key criteria when determining coverage of home oxygen therapy. The NCD defines chronic stable state as “…not during a period of an acute illness or an exacerbation of their underlying disease.” Based on this NCD definition, all co-existing diseases or conditions that can cause hypoxia must be treated and the beneficiary must be in a chronic stable state before oxygen therapy is considered eligible for payment. In addition, the beneficiary must have a severe lung disease, such as chronic obstructive pulmonary disease, diffuse interstitial lung disease, cystic fibrosis, bronchiectasis, widespread pulmonary neoplasm, or hypoxia-related symptoms or findings that might be expected to improve with oxygen therapy (see Oxygen LCD for additional information). For beneficiaries with OSA to be considered in the chronic, stable state, OSA must be sufficiently treated such that the underlying severe lung disease is unmasked. This must be demonstrated before oxygen saturation results obtained during polysomnography are considered qualifying for oxygen therapy.

For beneficiaries with OSA, a qualifying oxygen saturation test for the purposes of determining Medicare home oxygen reimbursement may only occur during a titration polysomnographic study (either split-night or stand-alone). The titration PSG is one in which all of the following criteria are met:

1. The titration is conducted over a minimum of two (2) hours; and,
   
   
2. During titration:
   
   
   1. The AHI/RDI is reduced to less than or equal to an average of ten (10) events per hour; or,
      
   2. If the initial AHI/RDI was less than an average of ten (10) events per hour, the titration demonstrates further reduction in the AHI/RDI; and,
      
3. Nocturnal oximetry conducted for the purpose for oxygen reimbursement qualification may only be performed after optimal PAP settings have been determined and the beneficiary is using the PAP device at those settings; and,
   
4. The nocturnal oximetry conducted during the PSG demonstrates an oxygen saturation ≤ 88% for 5 minutes total (which need not be continuous).[/size]
   

If all of the above criteria are met, for the purposes of a qualifying oxygen saturation test, the beneficiary is considered to be in the “chronic stable state.” To be eligible for Medicare coverage and payment for home oxygen therapy for concurrent use with PAP therapy, in addition to being in the chronic stable state, the beneficiary must meet all other coverage requirements for oxygen therapy.

[Jay51]

Thank you very much Gideon for researching and posting this information.

[upsman]

Good info, Gideon. Thanks. 
Since I have COPD, I'll likely have to move to this phase of treatment eventually.