The First StepAccording to Medicare, if home oxygen is necessary to treat your illness and it will improve your functioning per your doctor's recommendation, you should take the following steps:
- Before calling the oxygen supply company, make sure you have a written prescription from your doctor for the home oxygen equipment and supplies that you'll need. This applies to the oxygen concentrator all the way down to the tubing. If you don't have a doctor's order, Medicare won't cover it. Make sure your prescription is signed and dated by your doctor.
- Make sure that your doctor has documented your need for oxygen in your medical record. Medicare will request your records before approving your home oxygen, and if your condition is not well-documented, they may deny your claim.
- Make sure that your oxygen supply company has the order in hand before billing Medicare. They must also keep the order on file.
Qualifying for Medical Oxygen and Home Oxygen Supplies
In order to qualify for medical oxygen that is covered by Medicare, oxygen must be needed on an ongoing basis and it must be used in the home. There are other requirements as well:
- You must have a severe lung disease or other condition that impairs your breathing. It must also be well-documented in your medical record.
- You must have a health condition that may be improved by using oxygen.
- You must have a PaO2 (as measured by arterial blood gases) that is less than or equal to 55 mg Hg (normal is 75-100 mg Hg) and a documented oxygen saturation level of 88% or less while awake, or that drops to these levels for at least 5 minutes during sleep.
- You must have tried alternative methods to improve your oxygenation, or they should have at least been considered and then deemed ineffective by your physician.
Who Needs Home Oxygen?
Not everyone who is short of breath needs oxygen. If your oxygen levels (as measured by your ABG's) show that you are chronically hypoxemic, meaning you have a long-term, insufficient supply of oxygen in your blood, then you are probably a good candidate for it. According to the Global Initiative for Obstructive Lung Disease, oxygen is generally introduced to COPD treatment when the ABG's and oxygen saturation levels fall within the ranges mentioned above.
What are the Benefits of Home Oxygen?
Benefits of home oxygen are numerous. Not only does using oxygen for at least 15 hours a day increase survival in some people with COPD, but, it can help people with lung disease prevent heart failure, a common complication of lung disease.
To find out more about the benefits of oxygen, read Oxygen Therapy Facts.
What Medicare Will and Won't Pay For
For Medicare to pay for oxygen and the additional supplies needed to administer it, you must have Medicare Part B coverage, and your doctor must write a prescription for the supplies, as well as the oxygen. Medicare is fairly generous when it comes to home oxygen equipment, and as long as you qualify, will pay for all or most of the following:
- the oxygen itself
- oxygen concentrators and other systems that furnish oxygen
- oxygen tanks and other storage containers
- oxygen delivery methods, such as nasal cannulas, masks and tubing
- portable oxygen containers if they are used to move about in the home
Like any insurance plan, however, there are some things Medicare won't pay for:
- portable oxygen that is used solely for sleep
- portable oxygen that is used only as a back-up plan to a home-based oxygen system
What To Do if You Think You Need Oxygen
Talk to your health care provider if you think you need oxygen. If you have a pulse oximeter at home, you can measure your own oxygen saturation levels. If you don't, you can compare prices here, or your doctor can measure it at your next appointment. Remember, oxygen is a drug and should never be used without a prescription.
For more information about oxygen, read the following: