Contractor clarifies respiratory policy

Monday, November 25, 2013

WASHINGTON – Medicare does not reimburse for home oxygen used specifically to treat obstructive sleep apnea (OSA) because it is not the primary treatment for that disease, even if beneficiaries cannot tolerate PAP devices, CGS Associates said in a recent FAQ sent to providers. The DME MAC said beneficiaries who use a PAP device to treat OSA and who are in need of oxygen for other chronic pulmonary conditions like COPD, however, qualify for reimbursement if they meet the requirements of the oxygen and PAP local coverage decisions (LCDs) and have been diagnosed using a titration polysomnogram.