Medicare changes coverage of home use of oxygen

Payment is typically predicated on coverage. In July, the Centers for Medicare & Medicaid Services (CMS) amended its national coverage determination (NCD) for home use of oxygen by reducing the period of initial coverage for certain qualifying patients from 120 days to 90 days, conforming with the 90-day statutory time period. The change was effective July 8, 2022.

This means that initial coverage for Medicare patients with conditions not covered in other parts of the NCD may be limited to the shorter of 90 days or the number of days included in your prescription at the Medicare administrative contractor’s (MAC) discretion. Oxygen coverage may be renewed if deemed medically necessary by the MAC. Please keep this change in mind as you prescribe home oxygen for your Medicare patients.

Last year, CMS revised its NCD to allow coverage of short- as well as long-term home use of oxygen "in both acute and chronic diseases of respiratory and non-respiratory origin, as is medically necessary." This change, which was aligned with AAFP comments provided to CMS, allowed for greater access to at-home oxygen supplies for patients not in the previously required chronic-stable state.

— Kent Moore, AAFP Senior Strategist for Physician Payment

Posted on Oct. 5, 2022