There is an update to Medicare guidelines for coverage of oxygen. This is being adopted by most DME(Including HART) and should make the process easier. These went into effect 1/1/23. This is a summary of the discussion with HART. I am certain there will be nuances that come up through the year.
Key changes
- Removal of medical necessity forms (This may still need to be completed for prior O2 but will likely phase out in 2023)
- Removal of language (eg alternative treatments have been tried or considered)
- Changing “chronic stable state” language to “time of need” (eg 3 months, lifelong)
- Allowing for coverage on acute and chronic conditions
- Patients new to oxygen will need repeat Oxygen testing 61-90 days after initiating (even if known to need lifelong), however a face to face is not required.
There are 4 groups
- Group 1– Hypoxemic patients. All patients covered if Sat of 88% or below or PaO2<55mmHg. Example if patient in for PNA and needs oxygen can be covered but needs repeat O2 dose in 61-90 days to continue.
- Group 2– Sat 89% with dependent edema suggestive of heart failure, Pulmonary hypertension or Cor Pulmonale, Erythrocythemia with HCT > 56%
- Group 3– chronic cluster headaches without hypoxemia
- Group 4– Diagnosis not covered
- Angina Pectoris without hypoxemia
- Dyspnea without cor pulmonale or hypoxemia
- Severe Peripheral vascular disease without hypoxemia
- Terminal illnesses that do not affect the ability to breath