Oxygen Services FAQ |
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MEDICARE/MEDICAID FAQ
What PO2/Oxygen saturation does a patient need to drop to before their insurance will cover the oxygen equipment at home? Medicare: ≤ 88 or ≤ 55 PO2 ABG test; recertification the 1st year
89% or 56-59 PO2 (as long as the patient has dependent edema due to CHF, or corornary pulmonale or pulmonary hypertension documented, or hematocrit >56%; recertification after 3 months.
MO Medicaid: ≤ 89%; tested every year.
KS Medicaid: ≤ 85%; tested every year. |
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Progressive Medical Equipment Phone: 913-894-4400 Fax: 913-894-4405 E-mail: mmartin@pmekc.com |
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Medicare/Medicaid |
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If a sleep study is the determining test for oxygen, will portable oxygen be covered? No. Medicare & Medicaid will not cover portable oxygen when a sleep study/nocturnal oximetry is performed.
How long is an ABG/saturation test valid? In-patient: Must be taken within 48 hours prior to discharge of an in-patient facility, such as a hospital, rehab center, skilled facility, etc.
Out-patient: 30 days; set up must be within 30 days of test date. |
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All insurance requires a respiratory diagnosis (COPD, CHF, sleep apnea, etc.) for coverage. |
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St. Louis office: 5988 Mid Rivers Mall Drive St. Charles, MO 63304 Phone: 314-256-9640 |
