November 9, 2012
Coverage Reminder - Testing for Oxygen and Oxygen Equipment Coverage
Coverage for oxygen and oxygen equipment is dependent upon the presence of conditions that cause chronic hypoxemia. When the underlying condition is in the chronic stable state, blood oxygen testing may be performed by a qualified provider of laboratory services to evaluate the degree of hypoxemia. This result is used to assess eligibility for Medicare reimbursement for oxygen and oxygen equipment. This article serves to summarize essential information regarding oxygen testing.
There are two types of tests that may be used to assess the beneficiary. Acceptable tests are:
- Arterial Blood Gas (ABG) testing – direct testing of oxygen content from an arterial blood sample
- Oximetry – also known as "spot" or "pulse" oximetry involves the determination of percent (%) oxygen saturation via a transcutaneous sensor. There are three types of oximetry testing used for qualification for payment:
- At rest oximetry
- Overnight oximetry
- Exercise oximetry
For purposes of oxygen reimbursement, all testing must be performed as a stand-alone test and not as a part of a more extensive or complex test such as home sleep testing for obstructive sleep apnea or cardiac stress testing. A single exception exists for titration polysomnography. Refer to BOTH the Positive Airway Pressure Devices and Oxygen and Oxygen Equipment policies for additional information about this testing scenario.
For purposes of oxygen reimbursement, all testing must be performed by a qualified provider of laboratory services and be directly supervised by medical personnel qualified to perform the test. A single exception exists for home overnight oximetry. Refer to the Oxygen and Oxygen Equipment policy for additional information about this testing scenario.
Exercise oximetry requires that three (3) oximetry values be obtained during the same testing session. The three requires tests are:
- At rest oximetry on room air showing a non-qualifying result
- Oximetry while exercising on room air showing a qualifying result
- Oximetry while exercising on oxygen showing an improvement in the hypoxemia identified while exercising on room air
Oximetry obtained after exercise while resting, sometimes referred to as "recovery" testing, is not part of the three required test elements for exercise testing and is not valid for determining eligibility for oxygen coverage. For billing purposes, the test result obtained while exercising on room air should be reported on the Certificate of Medical Necessity (CMN).
Testing for oxygen qualification is associated with two additional requirements, which must be met in order for the testing to be acceptable for reimbursement. These requirements are:
- Timing of the test
- For all oxygen groups (i.e., Group I, II and III), initial testing must be done within the 30 days before the initial date of service
- For Group II beneficiaries, recertification testing must be done between day 61 – 90 after the initial date of service
- Treating physician visit
- For all oxygen groups (i.e., Group I, II and III), for the initial testing, a physician visit must be done within the 30 days before the initial date of service
- For all recertification's, a physician visit must be done within 90 days before the recertification date
Refer to the Oxygen and Oxygen Equipment LCD and related Policy Article at http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx, for additional information.