Home Use of Oxygen

Home oxygen therapy is nationally covered for patients with documented hypoxemia defined by specified arterial PO2 and arterial oxygen saturation thresholds at rest, during sleep, or during exercise, and for patients with borderline PO2 (56–59 mm Hg or 89% saturation) when accompanied by specific complications (congestive heart failure, pulmonary hypertension/cor pulmonale, or hematocrit >56%). Initial coverage requires clinical testing (arterial blood gas or supervised pulse oximetry) ordered and evaluated by the treating practitioner with tests done at the time of need (inpatients within 2 days of discharge). Coverage is not provided for non-hypoxemic angina, breathlessness without hypoxemia or cor pulmonale, peripheral vascular disease–related extremity desaturation, or terminal illness unless breathing is affected; MACs have discretion for limited initial coverage, renewals, and portable oxygen allowances.

"Resting hypoxemia: arterial PO2 ≤ 55 mm Hg OR arterial oxygen saturation ≤ 88% taken at rest on room air."