CMS proposes amendment to initial coverage for oxygen

WASHINGTON – CMS is accepting comments on a proposal to amend the period of initial coverage for certain home oxygen patients from 120 days to 90 days to align with the 90-day statutory time period set out in the national coverage determination issued Sept. 27, 2021. 

In a decision memo, CMS stated: “We are proposing that the first paragraph of section D will state: Effective [XX, XXXX], the MAC may determine reasonable and necessary coverage of oxygen therapy and oxygen equipment in the home for patients who are not described in section B or precluded by section C of this NCD. Initial coverage for patients with other conditions may be limited to the shorter of 90 days or the number of days included in the practitioner prescription at MAC discretion. Oxygen coverage may be renewed if deemed medically necessary by the MAC.” 

On Sept. 27, 2021, CMS updated NCD 240.2, Home Use of Oxygen, updating section D of NCD 240.2 to allow MACs to determine reasonable and necessary coverage of oxygen therapy and oxygen equipment in the home for patients who are not described in section B or precluded by section C of that coverage determination. Further, section D specifies that the initial coverage period for patients with these conditions may be limited to the shorter of 120 days or the number of days included in the practitioner prescription at MAC discretion. 

When finalizing the language in NCD 240.2 section D in response to public comments, CMS allowed for an initial coverage period of oxygen therapy and oxygen equipment in the home for up to 120 days for the beneficiaries who are not described in section B or precluded by section C of that coverage determination. However, at that time, the agency inadvertently neglected the 90-day time limit in §1834(a)(5)(E) of the act. 

The other sections of the NCD do not contain language related to the initial coverage period.