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Oxygen Use in Beneficiaries with Obstructive Sleep Apnea FAQs

Medicare does not provide reimbursement for home oxygen as a treatment of Obstructive Sleep Apnea (OSA). However many beneficiaries with OSA have co-existing chronic pulmonary conditions that would justify coverage of home oxygen, after appropriate titration polysomnogram (PSG) and meeting the requirements specified in the Oxygen Local Coverage Determination (LCD) and LCD-related Policy Article (PA). Both the Oxygen and the Positive Airway Pressure (PAP) Devices LCDs and related PAs contain detailed information about the testing necessary to justify payment of home oxygen. This FAQ discusses some of the common scenarios seen. Refer to the LCDs and LCD-related PAs for detailed information about coverage of PAP and home oxygen.

Following the Q&A, an algorithm is included to assist in analyzing OSA / home oxygen testing scenarios. Note that the algorithm does not itemize all coverage requirements for OSA or home oxygen. It is intended as an overview of qualification testing. Refer to the LCDs and LCD-related PAs for detailed information about payment rules.

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Refer to the relevant LCD and related Policy Article for details about coverage and documentation requirements.


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