CMS Considers Changing Home Oxygen Requirements

BALTIMORE–CMS said last week it is considering expanding its
coverage criteria for home oxygen. On Tuesday, the agency issued a
national coverage determination reconsideration of the current
12-year-old policy.

The need for supplemental oxygen is assessed by measurement of
the partial pressure of oxygen (in millimeters of mercury, mm Hg)
and the oxygen saturation of hemoglobin in arterial blood
(expressed as a percent). The present policy, which has been in
effect since October 1993, covers home oxygen for beneficiaries
with oxygen partial pressure measurements at or below 55 mm Hg or
oxygen saturation at or below 88 percent. If certain other
diseases/conditions are present, an oxygen partial pressure of
56-60 mm Hg or an oxygen saturation of 89 percent are
permitted.

The reconsideration will determine whether there is enough
evidence to include beneficiaries with arterial oxygen partial
pressure measurements in the range of 56 to 65 mm Hg.

These are typically patients who would be coming out of a
hospital, and usually their oxygen levels normalize within a few
months, according to Vernon Pertelle, corporate director of
respiratory/HME services for Apria Healthcare, Lake Forest, Calif.
However, he continued, “It would be a good thing to cover those
patients, especially if there are concerns with a patient’s ability
to stay out of the hospital, because it would save money,” he
said.

Pertelle said the matter is one of the many topics that will be
discussed at this week’s Sixth Oxygen Consensus Conference in
Denver, where an invitation-only group of doctors, clinicians,
patients and other experts will tackle issues relating to long-term
oxygen therapy (LTOT).

To view the tracking sheet or to comment on the policy, click
here.

For more on the conference, visit www.ltotnet.org.