Oxygen is administered by devices that provide controlled oxygen concentrations and flow rates. Oxygen therapy should maintain adequate tissue and cell oxygenation while avoiding oxygen toxicity.
Oxygen and oxygen supplies may be considered medically necessary for appropriately selected individuals only in cases when oxygen is prescribed by a physician. The prescription must specify:
Oxygen therapy may be considered medically necessary for:
Oxygen therapy for indications other than those listed above (and during sleep as listed below) is considered not medically necessary.
Supplemental home oxygen therapy may be considered medically necessary during sleep in an individual with ANY of the following conditions:
Oxygen therapy is considered not medically necessary for the following conditions:
Portable oxygen systems may be considered medically necessary only if the individual ambulates on a regular basis.
Supplemental home oxygen therapy during sleep for indications other than those listed above is considered not medically necessary.
Oxygen saturations cannot be performed by a Durable Medical Equipment company or a respiratory equipment provider.