CMS Considers Changing Home Oxygen Requirements

Baltimore

CMS is considering expanding its coverage criteria for home oxygen, according to 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 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 or conditions are present, an oxygen partial pressure of 56 to 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.