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Medicare Oxygen Therapy Guidelines for 2021


Medicare coverage for oxygen therapy is available when your doctor prescribes it to treat a lung or respiratory condition. Oxygen therapy can serve as a source of relief for those with severe asthma, COPD, emphysema, or other respiratory diseases. Medicare covers oxygen therapy in a hospital or at home when you meet specific guidelines. Below we discuss the requirements necessary to qualify for oxygen supplies.

Does Medicare Cover Oxygen Therapy?

Yes, oxygen therapy, as well as oxygen therapy tank accessories, are covered under Part B.  Oxygen equipment and all accessories are Durable Medical Equipment. Part B covers the rental and use of DME for beneficiaries to use within their homes. Medicare covers storage containers for oxygen, tubing, other oxygen accessories, and units that provide oxygen. Also, if the oxygen machine works with a humidifier, this may have coverage.

For Medicare to cover oxygen equipment and supplies, beneficiaries must have the following:

  • Have a prescription from your doctor
  • Have documentation from your doctor showing you have a lung disorder preventing you from receiving enough oxygen and that other measures have not been successful in improving your condition
  • Proof of gas levels in your blood from your doctor

It’s more cost-effective to rent your oxygen equipment from a participating DME supplier. Your rental payments will be paid up to 3 years. After that, the supplier will still own the equipment. However, they must still supply oxygen to you for an additional 24 months. If you still need oxygen therapy after 5 years, you can renew your contact with the supplier or find a new one.

If you use an oxygen concentrator, your Part B benefits will cover the cost of servicing your equipment every 6 months once the 36-month rental window has ended.

Does Medicare Cover Portable Oxygen Concentrators?

While Medicare covers small liquid portable tanks, oxygen concentrators are not part of the coverage. Oxygen concentrator devices are much more expensive. This is why suppliers choose to cover the smaller portable oxygen tanks instead since it’s much more cost-effective. Medicare will only approve one payment for oxygen therapy.

How Much Does Oxygen Cost with Medicare?

Typically, canned oxygen with a concentration of around 95%, runs at about $50 per unit. Canned oxygen could be costly if you were to rely on the constant use of an oxygen machine. Costs could quickly escalate to more than $1,160 per day and more than $426,000 per year!

However, with Part B coverage, you’ll only be responsible for the 20% coinsurance. Unfortunately, this can still be too much for most beneficiaries to spend out of pocket. This is why many choose to enroll in a Medicare Supplement plan, to cover this coinsurance as well as other cost-sharing such as deductibles.

Does Medicare Cover Hyperbaric Oxygen Therapy?

Hyperbaric Oxygen Therapy is a form of therapy where your whole body gets exposed to oxygen through increased atmospheric pressure. The oxygen distributes through a chamber. Medicare usually includes coverage for this therapy.

Will Medicare Advantage Offer Coverage for Oxygen Therapy?

Advantage plans must cover the same health services and equipment that Medicare includes. Fortunately, oxygen falls within this category. However, costs associated with coverage may vary since these plans are through private insurance companies. The best bet is to contact the carrier to determine the coverage guidelines for oxygen therapy. The carrier is the one who sets how much they cover. So, they may cover it, but they may cover less than what Medicare would’ve covered.

Do Medicare Supplement Plans Cover Oxygen Therapy?

Yes, supplement plans help cover the 20% coinsurance that Medicare doesn’t cover. It also covers other cost-sharing in the form of deductibles Choosing Medigap means you choose peace of mind. For those wanting to protect retirement savings, a Medicare Supplement plan will do just that.

How to Get Coverage for Oxygen Therapy Under Medicare

If you’re new to Medicare, or not new and just looking for better coverage, we can help! Our services are completely free. Our job is to educate you on all your options so that you can make the best decision on your healthcare. Give us a call today. Can’t call in now? No worries, fill out our online rate comparison form and discover all options available in your area.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

24 thoughts on “Medicare Oxygen Therapy Guidelines for 2021

  1. Does Medicare treat a patient differently if they are in Hospice care or Palliative care? My wife has a prescription for 5/10 l/minute (at rest/moderate motion) but needs an increase to 10/15 l/min. That requires two concentrators used together. We have been told by a hospice provider that Medicare will only pay for 1 concentrator and no reserve tanks. Can this be right?

    1. Hi Russell! Firstly, I’m so sorry you’re dealing with this. Since this sounds like something that would be handled in a case-by-case scenario, I would contact Medicare directly WITH the hospice care provider either on the phone via 3-way call or physically with you. This will help you get the problem resolved much quicker and avoid he said she said and going back and forth.

  2. If a Medicare patient is at the end of their 5 Year RUL for their oxygen equipment and is needing oxygen supplies but has not yet been to their doctor to re-qualify for the Oxygen. Can the providing Oxygen supplier refuse to deliver Oxygen supplies to that patient until he/she is requalified for their Oxygen?

    1. Hi Michelle! The oxygen equipment is a prescription, so the Durable Medical Equipment supplier could possibly deny you the supply of the prescription is not up to date. However, if you call the physician they may renew the prescription without having you come into the office or do the exam possibly virtually with Telehealth.

  3. My husband suffers from CHF. He uses a Cpap for sleep but often wakes unable to breathe. I have had to call an ambulance4 times in 4 months and he has been hospitalized from 2-7 days to stabilize his oxygen levels. Once he is on oxygen, his saturations levels improve to above 95%. We are trying to get Medicare to approve portable home oxygen so these ambulance and hospital trips are unnecessary We keep being told that because his sat level is not consistently 88 or below, he doesn’t qualify.. it’s like a catch 22. We cannot sustain the cost of this life saving oxygen out of pocket. What recourse might we have?

    1. Hi Joyce,
      Just ran across your situation and thought I’d give you a couple options to help your husband get oxygen. He can qualify for portable and concentrator by a spot check of his O2 sat being 88% or below. This has to be done in a chronic stable state (not in an emergency situation) at a Drs. visit or in patient hospital stay.

      Another option would be an exercise test at a Drs. visit or hospital stay. Again, he needs to be in a chronic stable state. The first documented sat needs to be at rest (setting) on room air. The second documented sat needs to be ambulating on room air. The third documented sat needs to be ambulating with oxygen applied to show improvement. As long as he desats to 88% or below, he would qualify for Oxygen.

      In both the above cases the desaturation does not have to be consistent. Just documented by chart notes or test results.

      The actual best route to take would be a titrated sleep study because he uses a CPAP. He would have to go into a sleep center, they would optimize the CPAP usage to show that his Obstructive Sleep Apnea is treated and then document his oxygen sats. This test would be the most accurate to see what is going on with him while he’s sleeping. His oxygen sats need to be below 88% for 5 minutes (does not have to be 5 continuous), with a minimum sleep time of 2 hours.

      Without knowing your husbands situation at all, he may need more therapy for his sleep problems. Maybe his settings need changed. Maybe he needs to be considered for a BiPap. The sleep study would answer those questions for you.

      Irregardless, the 88% or below does not have to be consistent (with the exception of the 5 minute rule for sleep study and it can be cumulative). Your doctor or CPAP supplier should be able to help you with getting him qualified if needed.

      Hope this helps. You’re not caught in a catch 22! Just need the correct documentation and testing. Best wishes – Toni Murphy DME supplier/biller for 20 plus years.

  4. I work a clinical care coordinator at a ILD clinic. We see patients from many parts of California at sea level. My doctor has ordered our patient a higher flow oxygen concentrator due to progression of her disease process. She lives at 5600 ft elevation. It was my understanding due to Covid-19 and assisting in reducing patients exposures that CMS has waived the requirement for saturation testing results to prove patient requires 4 lpm oxygen to maintain saturations above 90%. Is this true?

    1. Hi Bill! Clinicians can provide remote patient monitoring services for patients, no matter if it is for the COVID-19 disease or a chronic condition. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry. I would contact Medicare directly to find out if saturation testing has been waived.

  5. My ‘2nd’ dad has been on oxygen for over 5 years. If he passes away will we be required to turn his oxygen machine back in?

    1. Hi Sandy! If your father has been using the equipment for more than five years, you won’t have to return it. Anything less I would contact the Durable Medical Equipment company to see if they want you to return it. You would not return it to Medicare, but the company he purchased the equipment from who accepted payment from Medicare.

  6. Does Medicare cover liquid oxygen? Recently diagnosed with PF and need oxygen 24/7. Looking for optional portable to use instead of oxygen tanks.

  7. I suffer from severe chronic daily headaches. I learned that oxygen treatments are often helpful for pain relief. Is Medicare paying for these treatments? From what I learned it takes several treatments.

    1. If your doctor finds the treatment is medically necessary, then Medicare will cover it. How much is covered depends on what parts and plans of Medicare you’re enrolled in. Let me know if you have any more questions!

  8. I am a heart failure patient and my doctor has put me on oxygen at night. At the beginning I was told I would be on oxygen for the rest of my life. Now my oxygen supplier is telling me I need to be re-evaluated annually or Medicare will not cover it. My doctor disagrees. What do you say?

    1. Hi Elisabeth! Your supplier is correct. Since oxygen is a prescription, you’re required to get re-evaluated annually to have your prescription renewed each year.

  9. I am a pulmonary physician. I have a national virtual medical practice that does cash py consults and often get referral from concentrator vendors. If I see a patient using my telemedicine portal and they ask me for a prescription for an oxygen concentrator (they are already on oxygen prescribed by thier own physician) do I have to have “documentation or proof” that they have COPD, pulmonary hypertension, pulmonary fibrosis etc or can I take the patients word for it? I usually just make sure I ask the patient about thier underlying diagnosis, what oxygen liter flow they are on and that thye are mobile and will benefit from buying a concentrator.

    1. Hi Jagdeep! Great question. Since your patient has already been prescribed an oxygen concentrator from their previous physician, you most likely won’t have to provide documentation or proof that the patient has been diagnosed with one of the conditions you listed. I would still recommend you have this documentation sent over from your patients’ previous physician so you have it on record just in case. However, if your patient has a reversible condition, such as Pulmonary Hypertension, CMS may require that you submit documentation or proof that they still have this condition after a certain amount of time and still need an oxygen concentrator. I hope this helps!

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