Oxygen is covered if you have significant hypoxemia in a chronic stable state when:
You have a severe lung disease or hypoxemia that might be expected to improve with oxygen therapy, and
Your blood gas levels or oxygen saturation levels indicate the need for oxygen therapy, and
Your oxygen study was performed by a qualifying physician or sleep lab, and
Alternative treatments have been tried or deemed clinically ineffective.
Categories/Groups are based on the test results to measure your oxygen:
Group I Criteria: mmHG = 55, or saturation = 88%
For these results you must return to your physician between 9-12 months after the initial visit to discusss whether your oxygen therapy should continue for lifetime or for a shorter period if the need is expected to end. Typically, you will not have to be retested when you return to your physician for the follow-up visit.
Group II Criteria: 56-59 mmHg, or 89% saturation
For these results, you must return for another office visit with your physician to discuss your oxygen therapy and you will also have to be retested within 3 months of the first test to continue therapy for lifetime or until the need is expected to end.
Group III Criteria: mmHg = 60 or saturation = 90% is considered to be not medically necessary.
Oxygen will be paid as a rental for the first 36 months. After that time, if you still need the equipment, Medicare will no longer make rental payments on the equipment. However, if equipment is still necessary, your provider will continue to provide the equipment to you for an additional 24 months. During this two year service period, Medicare will pay your provider for refilling your oxygen cylinders and for a semi-annual maintenance fee.
After 60 months of service through Medicare you may choose to receive new equipment.