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CMS Issues Home Oxygen Guidance to DME MACs

AAHomecare Alert 2/14/2022


CMS has published guidance to the DME MACs on the revisions made to the National Coverage Determination (NCD) for Home Use of Oxygen (240.2) and removal of Home Oxygen Use for Cluster Headache (240.2.2). The guidance, Change Request 12607, informs the DME MACs on the updates that were finalized for the Home Use of Oxygen NCD in September 2021. CMS notes the following changes are effective for claims with a date of service starting September 27, 2021:

  • Expansion of oxygen coverage for acute and chronic conditions (when hypoxemia exhibited);
  • Expansion of oxygen coverage for short and long-term need (when hypoxemia exhibited); 
  • DME MACs may determine whether ordered oxygen and oxygen equipment are reasonable and necessary; and
  • Removal of Home Oxygen Use for Cluster Headache (240.2.2) and allowing DME MACs to make coverage determinations for patients with cluster headaches.

This is the first guidance CMS has published publicly to the DME MACs regarding the updated Oxygen NCD.  The changes highlighted in the Change Request are intended to expand patient access to home oxygen therapy nationally.

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