Baltimore
CMS is considering expanding its coverage criteria for home
oxygen, according to a national coverage determination
reconsideration of the current 12-year-old policy.
The need for supplemental oxygen is assessed by measurement of
the partial pressure of oxygen (in millimeters of mercury, mm Hg)
and the oxygen saturation of hemoglobin in arterial blood
(expressed as a percent).
The present policy, which has been in effect since 1993, covers
home oxygen for beneficiaries with oxygen partial pressure
measurements at or below 55 mm Hg or oxygen saturation at or below
88 percent. If certain other diseases or conditions are present, an
oxygen partial pressure of 56 to 60 mm Hg or an oxygen saturation
of 89 percent are permitted.
The reconsideration will determine whether there is enough
evidence to include beneficiaries with arterial oxygen partial
pressure measurements in the range of 56 to 65 mm Hg.
These are typically patients who would be coming out of a
hospital, and usually their oxygen levels normalize within a few
months, according to Vernon Pertelle, corporate director of
respiratory/HME services for Apria Healthcare, Lake Forest, Calif.
However, he continued, “It would be a good thing to cover
those patients, especially if there are concerns with a patient's
ability to stay out of the hospital, because it would save
money,” he said.
