CMS Instructs DME MACs on Oxygen NCD Changes

The two separate, but medically related NCDs should expand access to home oxygen services.

CMS has published guidance to the DME MACs based on changes it made to the National Coverage Determinations (NCDs) for home oxygen use and for the use of home oxygen to treat cluster headaches.

The guidance is based on two NCD changes CMS finalized in September. Specifically, CMS removed the NCD for Home Oxygen Use to Treat Cluster Headaches (240.2.2) and revised the NCD for Home Use of Oxygen (240.2). 

“This is the first guidance CMS has published publicly to the DME MACs regarding the updated Oxygen NCD,” a statement from the American Association for Homecare read. “The changes highlighted in the Change Request are intended to expand patient access to home oxygen therapy nationally.”

The guidance, Change Request 12607 (available as a PDF), makes the following changes effective for claims with a date of service starting Sept. 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.
  • Removal of Home Oxygen Use for Cluster Headache (240.2.2) and allowing DME MACs to make coverage determinations for patients with cluster headaches.

 

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