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, pneumonia.
Blood gas study meets criteria indicated below:
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
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 provideall three test results described above; otherwise the oxygen will not be covered.
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.
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 DETIALS, OR ANY QUESTIONS.