CMS (Medicare/Medicaid) Requirements for Nocturnal Supplemental Oxygen

These requirements must be met or durable medical equipment (DME) companies are required by Medicare to take the oxygen equipment.

People who require oxygen during the day do not fall under these rules.

  1. If the patient has, or is suspected to have sleep apnea, patient must be tested in a facility setting to prove PAP (Positive Airway Therapy) therapy does not work on it’s own and oxygen is needed to supplement the treatment.

    • No home testing is allowed currently.

    • CMS will no longer pay solely for Nocturnal Supplemental Oxygen should patient have the diagnosis of Sleep Apnea. The Sleep Apnea patient must be using PAP therapy in order to be in consideration for oxygen.

  2. The patient must maintain PAP compliance (using the machine ≥ 4 hours a day 70% of a current 30 day window).

    • Should a person show non-compliance:

      • They will not have oxygen approved by CMS.

      • They will not get PAP supplies approved by CMS.

      • If the PAP machine is a newly purchased, this too will not be approved by CMS, and they will have the DME pick up the machine from your house.

The entire process will have to be started over per CMS guidelines (See Initial Start to Investigate a Sleep Disorder).

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