Medicare Coverage of Home Oxygen
People suffering from hypoxemia are thought to have a suitable and facilitative healthcare option of home oxygen supply which is taken care of under Medicare provisions, particularly under the durable medical equipment benefit. This benefit is given after verification through the health condition of the patient, laboratory evidence, and a statement of their medical documents. The details of this benefit are described under 186 (s) (6) of Social Security Act which describes the criteria for providence of portable oxygen facility as well as clarifying that respiratory therapist services are not covered under the allotted provisions for home oxygen service coverage.
Section B: Medical Documentations
The first section of 186 (s) (6) of the Social Security Act requires a completed Form CMS 484 in order to make sure that the criteria for provision of home oxygen services are met. This also ensures that the services being provided are in line with the prescriptions made by the professional attending to the patient. The details on this form are only to be filled by the professional therapist, his employees, or clinicians who are in charge of tending to the patient in question. This can include a nurse or any respiratory therapist. This section also lays down detailed instructions about which professional is expected to play a role in providing home oxygen care and in what way. It also calls for statement of specific details regarding each case, including the diagnosis of the disease, the rate of oxygen flow, frequency, and usage duration, to name a few.
This section requires laboratory evidence to support the claim that a patient is in need of home oxygen service. For this requirement, a blood gas / overnight oximetry study would need to be done, the results of which must be attached to verify this section. Further clarification on details regarding laboratory evidence is also made under this section of the act.
Section D: Health Conditions
If a person is in severe hypoxemia chronic stable state, coverage will be provided on 3 conditions which include several sub-situations and case options.
Section E: Portable Oxygen System
Sub-section C of 186 (s) (6) of Social Security Act clarifies the requirements specified for coverage of portable oxygen system. If the patient fulfills the requirements, a portable oxygen system is either provided by itself or in addition to a stationary oxygen system.
Section F: Respiratory Therapist
This section is a statement which mentions that in the absence of respiratory therapist services, only the equipment for home oxygen services would be provided. Home oxygen services use IDTF's for overnight oximetry testing. Especially in conditions like hypoxemia, sleep apnea, etc, overnight oximetry testing is very crucial and requires proper equipment which can be expensive without coverage under Medicare.