Oxygen - Medical Clinical Policy Bulletins

Home oxygen therapy is covered when a member has a severe lung disease or hypoxia-related symptoms that are expected to improve with treatment, and when a qualifying blood gas study is conducted, particularly during an inpatient stay or while the member is stable. Short-term oxygen therapy for conditions such as asthma or pneumonia is also covered, typically for up to one month. Key limitations include the requirement for previous treatment attempts, specific blood gas testing conditions, and lack of coverage during acute illness or exacerbations, along with necessary documentation from a physician.

"Home oxygen therapy is considered medically necessary when all specified conditions are met."

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