Medicare is actively enforcing the following guidelines when documenting the need for home oxygen. The physician must clearly DOCUMENT the need for home oxygen in the medical record in order for it to be covered by Medicare.
The following criteria must be MET and DOCUMENTED by the PHYSICIAN to qualify for home O2:
-PaO2 ≤ 55mmHg
-SaO2 ≤ 88% while awake, asleep, and at rest
If the above criteria are only met with exertion, 3 tests are required:
1. On room air, AT REST
2. On room air, DURING EXERTION
3. On oxygen, DURING EXERTION
If the test is done during sleep, it must show at least 5 minutes (not continuous) of SaO2 ≤ 88% or PaO2 ≤ 55mmHg.
HOWEVER, if the patient has severe lung disease or hypoxia-related symptoms that might be expected to improve with oxygen therapy, this is acceptable for Medicare coverage.
Values must be recorded within 48 hours prior to discharge from the hospital.
The physician MUST complete the Certificate of Medical Necessity – Oxygen DME form CMS-484.
Download the complete tip, Guidelines for Home Oxygen for Medicare Patients.