Concentrator Requirements
The requirements for concentrators include, but are not limited to, the following:
- Patient has a servere lung disease or hypoxia-related symptom that might improve with therapy.
- Examples:
- COPD, diffuse interstitial lung disease, bronchiectasis, or cystic fibrosis
- Hypoxia-related symptoms such as pulmonary hypertension, recurring CHF due to chronic cor pulmonale, erythrocytosis, impairment of cognitive process, nocturnal restlessness, and morning headache
- Hypoxemia alone will not be covered. There needs to be an underlying condition causing the hypoxemia.
- Non-Covered Conditions: Angina pectoris in absence of hypoxemia, breathlessness without cor pulmonale or hypoxemia, servere peripheral vascular disease, terminal illnesses that do not affect lungs, and pneumonia
- Examples:
- Blood gas study meets the criteria indicated below:
- Method 1:
- On room air at rest while awake, oxygen saturation equal to or less than 88 percent or ABG equal to or less than 55 mm Hg
- Method 2:
- If during exercise, must have the following three tests documented:
- Oxygen saturation on room air at rest (should be above 88 percent)
- Oxygen saturation on room air with exercise (needs to be equal to or less than 88 percent)
- Oxygen saturation on oxygen with exercise (shows improvement with oxygen)
- NOTE: If patient qualifies with method 2, then WHOMEVER does the testing must document and provide all three test results described above, otherwise the oxygen will not be covered.
- If during exercise, must have the following three tests documented:
- Method 3: During sleep on room air oxygen saturation equal to or less than 88 percent for at least 5 minutes and does not have to be continuous
- Method 1:
3. Alternative treatment measures, such as inhalers or nebulizer treatments, have been tried or considered, and ruled out or clinically ineffective.
*THE ABOVE IS THE CRITERIA THAT MUST BE MET FOR MEDICARE. THESE MAY NOT BE THE ONLY REQUIREMENTS. PLEASE CALL JAY'S MEDICAL EQUIPMENT FOR FURTHER DETAILS, OR ANY QUESTIONS.