NCD 240.2: Home Oxygen Therapy
Medicare covers home O2 for chronic lung disease, hypoxemia-related conditions, with specific PaO2 / SpO2 / ABG criteria.
What's covered
- Continuous O2 for PaO2 ≤55 mmHg or SpO2 ≤88% at rest on room air
- Nocturnal O2 for PaO2 ≤55 mmHg during sleep
- Exercise O2 for PaO2 ≤55 mmHg or SpO2 ≤88% during exercise
- Conserving devices (transtracheal, OCS) when criteria met
Coverage criteria
- ABG or O2 saturation within 2 days of hospital discharge OR during stable disease state
- Conservative measures tried
- Underlying lung disease documented
Exclusions
- Symptomatic relief without qualifying PaO2/SpO2
- Cluster headache (separate NCD applies)
Common denial patterns
- Testing during exacerbation (not stable state)
- Missing 2nd qualifying test for borderline values
- Equipment supplier not enrolled correctly
Appeal citation
NCD 240.2 (Home Use of Oxygen). Cite ABG/SpO2 with date, lung disease diagnosis, prior conservative treatment.
Frequently asked questions
What does Medicare NCD 240.2 cover?
Medicare covers home O2 for chronic lung disease, hypoxemia-related conditions, with specific PaO2 / SpO2 / ABG criteria.
What are the coverage criteria?
ABG or O2 saturation within 2 days of hospital discharge OR during stable disease state; Conservative measures tried; Underlying lung disease documented.
What is excluded?
Symptomatic relief without qualifying PaO2/SpO2; Cluster headache (separate NCD applies).
How do I cite this NCD in an appeal?
NCD 240.2 (Home Use of Oxygen). Cite ABG/SpO2 with date, lung disease diagnosis, prior conservative treatment.
Other Respiratory/DME NCDs
Sources
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