How to Qualify for Home Oxygen Therapy
Home oxygen therapy will move you toward living a more comfortable life. From the outside looking in, the act of getting an oxygen machine for home use can seem a complicated and difficult process.
Below we’ve outlined the steps you’ll need to take to complete this process. Follow along and hopefully we’ll answer all your questions about acquiring home oxygen therapy and meeting Medicare oxygen guidelines.
Overview: Qualifying for Home Oxygen
First, if you want to receive home oxygen treatment you’ll need to meet the following criteria:
- Be evaluated by a doctor, in-person
- Have a medical record that documents your need for oxygen therapy
- Show diminished oxygen saturation on an arterial blood gas study
- Receive a prescription from a qualified healthcare professional
Read on for an in-depth description of this process.
Step 1: Get an In-Person Evaluation
This multi-step process begins with a consultation from a qualifying professional. You’ll want to discuss with your doctor whether you have a medical condition that can be improved through portable oxygen. These conditions may include emphysema, COPD, bronchitis, and many other chronic conditions.
Your in-person evaluation must be with one of these treating practitioners:
- Physician (medical doctor, doctor of osteopathy, or doctor of pediatric medicine)
- Nurse practitioner (NP)
- Clinical nurse specialist (CNS)
- Physician assistant (PA)
Step 2: Procure a Medical Record
You must have medical record that contains sufficient documentation of a medical condition to substantiate the need for oxygen therapy in the home.
Included in this medical record:
- Diagnosis
- Duration of condition
- Clinical course (worsening or improving)
- Prognosis
- If portable oxygen is needed, an indication that you are mobile within the home
- Nature and extent of functional limitations
- Other therapeutic interventions and results
- Experience with related items
- Other pertinent information
Step 3: Undergo a Blood Gas Study
Your documentation must include qualifying results from a blood gas study. Your blood gas study should demonstrate a diminished percentage of oxygen in your arterial system. Your physician will rate your need against several values that determine home oxygen therapy.
Step 4: Get a Prescription for Home Oxygen Therapy
After your face-to-face consultation and your blood gas study, your treating physician must complete all written forms required by your insurer. This includes a Written Order of Prior to Delivery (WOPD) and a Certificate of Medical Necessity (CMN), which is needed to qualify for Medicare.
Details regarding your therapy should be listed on the documentation, including:
- Flow rate and duration of oxygen use
- Delivery method
- Portability needs
- Physician signature and contact information
Covered Oxygen Items and Equipment for Home Use
According to the Centers for Medicaid and Medicare Services (CMS) the following items and equipment may be covered under the Medicare Guidelines for Oxygen, providing all requirements are met:
- Portable oxygen concentrators and other systems for furnishing oxygen
- Tubing and related supplies for the delivery of oxygen
- Vessels for storing oxygen
- Oxygen contents
Medicare Coverage Requirements
Medicare Oxygen Guidelines require that you meet the following conditions:
- Eligible for a defined Medicare benefit category
- Reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member
- Ordered by providers and furnished by suppliers who are enrolled in the Medicare Program
- Meet all other applicable Medicare statutory and regulatory requirements
Need specifics on your Medicare coverage? Please consult the Official US Medicare website.
