By: Christina Colegrove RN, BSN - Clinical Consultant
For beneficiaries who require simultaneous use of home oxygen and PAP therapy, it is important to remember that all of the requirements in both the Oxygen and Oxygen Equipment and Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea LCDs must be met.
Home oxygen therapy requires that the beneficiary is tested in a “chronic stable state” which means obstructive sleep apnea (OSA) must be sufficiently treated so the underlying severe lung disease is unmasked. For beneficiaries with OSA, a qualifying oxygen saturation test may only occur during a titration polysomnogram study in which the following criteria are met:
• The titration is conducted over a minimum of two hours; and
• During titration:
o The AHI/RDI is reduced to less than or equal to 10 events/hour; or
o If the initial AHI/RDI was less than 10 event/hour, the titration must demonstrate additional reduction in the AHI/RDI; and
• Nocturnal oximetry for oxygen qualification can only be performed after optimal PAP settings have been determined and the beneficiary is using the PAP device at those settings; and
• The nocturnal oximetry during the polysomnogram must show an oxygen saturation less than or equal to 88% for 5 minutes (continuous or non-continuous)
When the above criteria are met, the beneficiary is considered to be in a “chronic stable state.” Please note that to be eligible for Medicare coverage and payment for home oxygen for concurrent use with PAP therapy, the beneficiary must still meet all other coverage requirements for oxygen therapy as outlined in the LCD. It is also important to remember that beneficiaries who qualify for oxygen therapy based on testing conducted during a sleep test are only eligible for reimbursement of stationary equipment.