AAHomecare Analyzes CMS’s New Oxygen LCD

AAHomecare provides a point-by-point breakdown of the new LCD, which goes into effect Jan. 1, 2023.

On Nov. 18, CMS published a new Oxygen and Oxygen Equipment LCD and Policy Article and the American Association for Homecare has now examined the LCD and article and released key highlights of that analysis.

First, the LCD and policy article were based on three developments:

  1. New Home Use of Oxygen NCD 240.2
  2. Removal of Home Oxygen Use to Treat Cluster Headache NCD 240.2.2
  3. Elimination of Certificates of Medical Necessity (CMN) and DME Information Forms (Change Request 12734)

This new LCD will go into effect on Jan 1, 2023. Since these are non-discretionary changes to the LCD, CMS does not have to provide a commenting opportunity for stakeholders.

AAHomecare released highlights of its analysis of the changes of the new oxygen and oxygen equipment LCD and related policy article:

  • Removed the following: 
    • All references to CMNs. (Initial & RECERT)
    • Chronic stable state requirement
    • Severe lung disease criterion which no longer limits oxygen’s coverage to severe lung disease or hypoxemia related condition expected to improve with oxygen therapy
    • Alternative treatment method requirement

  • Since the CMN was eliminated, the 30 days requirement for the face to face and qualifying test was also eliminated. This was replaced with this statement: “the treating practitioner has ordered and evaluated the results of a qualifying blood gas study performed at the time of need.”  LCD defines time of need as “during the patient’s illness when the presumption is that the provision of oxygen will improve the patient’s condition in the home setting.” However, it clarified “for an inpatient hospital patient anticipated to require oxygen upon going home, the time of need would be within 2 days of discharge.”

  • Repurposed Group III criteria that allows coverage for patients with the absence of hypoxemia defined in Group I and Group II but have a medical condition with distinct physiologic, cognitive, and/or functional symptoms documented in high-quality, peer-reviewed literature to be improved by oxygen therapy, such as cluster headaches (not all inclusive).

  • Group IV was added to replace the previous Group III which now list the non-covered conditions for oxygen.
  • Formal re-evaluation and testing are not required for Group I patients. However, suppliers are still responsible to ensure oxygen and oxygen equipment remain reasonable and necessary. 

  • Group II patients should be re-evaluated and retested by the treating practitioner the between the 61st and 90th days after initiation of therapy. A new SWO by the treating practitioner is also required. 

  • Group III patients should be re-evaluated by the treating practitioner between the 61st-90th days after initiation of therapy. A new SWO by the treating practitioner is required. 

  • For patients leaving a hospital setting that need oxygen upon going home, blood gas study must be performed two days prior to discharge.  


About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on LinkedIn at linkedin.com/in/dkopf/ and on Twitter at @postacutenews.

HME Business Podcast