Friday, December 2, 2022

WASHINGTON (December 2, 2022)—The Centers for Medicare & Medicaid Services have published a new Oxygen and Oxygen Equipment LCD and related Policy Article that will go into effect on January 1, 2023. The Durable Medical Equipment Administrative Contractors (DME MACs) have also updated the local coverage determination (LCD) based on the new Home Use of Oxygen NCD.
 
The American Association for Homecare (AAHomecare) has provided an overview of the changes found in the Future Effective Oxygen and Oxygen Equipment LCD and related Policy Article:

  • Removed the following:
    • All references to CMNs. (Initial & RECERT)
    • Chronic stable state requirement
    • Severe lung disease criterion which no longer limits oxygen’s coverage to severe lung disease or hypoxemia related condition expected to improve with oxygen therapy
    • Alternative treatment method requirement
  • Since the CMN was eliminated, the 30-day requirement for the face-to-face and qualifying test was also eliminated. This was replaced with the statement “the treating practitioner has ordered and evaluated the results of a qualifying blood gas study performed at the time of need.”  The LCD defines time of need as “during the patient’s illness when the presumption is that the provision of oxygen will improve the patient’s condition in the home setting.” It further clarifies “for an inpatient hospital patient anticipated to require oxygen upon going home, the time of need would be within two days of discharge.”
  • Repurposed Group III criteria that allows coverage for patients with the absence of hypoxemia defined in Group I and Group II, but who have a medical condition with distinct physiologic, cognitive, and/or functional symptoms documented in high-quality, peer-reviewed literature to be improved by oxygen therapy, such as cluster headaches (not all inclusive).
  • Group IV was added to replace the previous Group III which now list the non-covered conditions for oxygen.
  • Formal re-evaluation and testing are not required for Group I patients. However, suppliers are still responsible to ensure oxygen and oxygen equipment remain reasonable and necessary.
  • Group II patients should be re-evaluated and retested by the treating practitioner between the 61st and 90th days after initiation of therapy. A new SWO by the treating practitioner is also required.
  • Group III patients should be re-evaluated by the treating practitioner between the 61st-90th days after initiation of therapy. A new SWO by the treating practitioner is required.
  • For patients leaving a hospital setting that need oxygen upon going home, a blood gas study must be performed two days prior to discharge.