Medicare Launches Efforts to Improve Care for Patients Using Oxygen

Health Care Coverage

The Centers for Medicare & Medicaid Services (CMS) announced (March 23) it intends to extend coverage for the home use of oxygen to Medicare beneficiaries enrolled in a CMS approved clinical trial sponsored by the National Heart, Lung & Blood Institute (NHLBI).

"This is an important opportunity to improve the care of our seniors, and to get better evidence on how doctors and patients can achieve the best outcomes for this serious and hard to treat condition," said CMS Administrator Mark McClellan, MD PhD.

Medicare currently provides coverage for home oxygen for beneficiaries with partial pressure measurements at or below 55 mmHg or oxygen saturation at or below 88 percent. If certain other diseases/conditions are present, coverage is provided for patients with an oxygen partial pressure of 56-60 mmHg or an oxygen saturation of 89 percent.

The trial will include Medicare beneficiaries with arterial oxygen partial measurements from 56 to 65 mmHg or whose oxygen saturation is at or above 89 percent who do not meet the current Medicare coverage requirements for home oxygen.

The amount of oxygen in arterial blood is generally expressed in one of two ways. The partial pressure of oxygen (pO2) is measured in millimeters of mercury (mm Hg), Hg being the scientific abbreviation for mercury.

This is analogous to the measurement of air pressure with a barometer, which is similarly reported in inches or millimeters of mercury. The other common measurement method looks at the percent of hemoglobin in blood that is saturated with oxygen. Hemoglobin is the protein in red blood cells that carries oxygen.

The final national coverage determination announced today will ensure funding for all clinical items and services are provided to patients enrolled in these trials, where funding for the home use of oxygen for those beneficiaries (meeting the qualifications as describe above) were not previously available.