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Medicare Oxygen Recertification Guidelines

Elderly woman using an oxygen inhaler for asthma

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If your doctor has prescribed oxygen therapy for either a respiratory or lung condition, your Medicare Part B will cover the charges.  Doctors often prescribe oxygen therapy for patients with conditions like COPD, emphysema, asthma, chronic bronchitis, cystic fibrosis, pulmonary fibrosis, or heart failure.  Medicare will cover the prescribed oxygen whether you are confined to a hospital, or using it at home.

Medicare Coverage Conditions for Oxygen

In order for Medicare to cover the oxygen therapy, the following conditions must be met:

  • You must have a prescription for the oxygen from your doctor
  • You must provide documentation from your doctor specifying that you have a lung and/or respiratory issue that prevents you from receiving enough oxygen and that other avenues have proven to be unsuccessful in improving your oxygen levels.
  • It is also necessary for your doctor to provide proof of the gas levels in your blood.
Hospital medical oxygen tanks
Medicare can cover the oxygen therapy.

A link to the CMS Form 484 (Certificate of Medical Necessity).

Medicare beneficiaries who are on oxygen must be recertified to determine if there is Continuing Medical Need (CMN) for the oxygen.  The first recertification is required at 3 months.  The second recertification takes place at 9 months.  This leaves a 90-day interval that will allow the physician time to submit the CMN.

This recertification is required 12 months after the initial certification.  There must be documentation stating that the beneficiary has been seen and re-evaluated by the treating physician within 90 days of the recertification date.

Recertification is also necessary when the oxygen equipment is replaced or has reached its useful lifetime as well as when oxygen equipment has been deemed irreparable.

Once recertification is achieved, there is no need to re-qualify/recertify in the future.


 

The article was written by Sonja Vaughan of Insurance Advisors of the Carolinas
Exclusively for bobbybrockinsurance.com and the Bobby Brock Insurance

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