Oxygen

Home oxygen is covered only when the treating physician documents severe lung disease or hypoxia-related symptoms and a qualifying blood gas study (performed by a physician or qualified provider) that meets Aetna’s criteria — inpatient tests must be the one closest to but no earlier than 2 days before discharge, outpatient chronic tests must be obtained while clinically stable, and ongoing therapy requires monthly review of repeat qualifying lab values. Oxygen is not medically necessary for other indications (e.g., angina without hypoxemia, dyspnea without cor pulmonale or hypoxemia, peripheral desaturation without systemic hypoxemia, terminal illnesses not affecting respiration), ongoing use for acute diagnoses like pneumonia/asthma/croup/bronchitis is generally limited to <1 month, and preset portable oxygen units are not medically necessary.

"Rental or purchase of oxygen equipment when selection criteria are met (Aetna will rent or purchase if less costly)"