5 Steps to Qualifying for Home Oxygen Therapy

If you think you have a health condition that would benefit from oxygen therapy and you are interested in getting oxygen at home, talk to your doctor about whether you meet the criteria for oxygen therapy. Ask about how to get an oxygen tank for home use, about home O2 requirements and anything else you need to know about getting oxygen at home. home oxygen therapy

If you are wondering, “Do you need a prescription for oxygen?”, the answer is yes. There are several factors for both you and your doctor to consider before you can obtain a prescription for supplemental oxygen. Medicare, Medicaid and commercial insurance companies may pay for home oxygen, but there are specific Medicare oxygen requirements, as well as requirements unique to other insurance companies. Payment for your oxygen supplies is based on each company’s unique criteria for oxygen therapy, which may include diagnosis, laboratory results and other information as summarized below.

The 5 Steps Needed to Qualify for Home Oxygen Therapy

To qualify for home oxygen therapy, consider taking the following 5 steps:

  1. Talk to your doctor about whether you have a qualifying medical condition for getting oxygen at home. This includes a lung condition or other condition that impairs your breathing. You may qualify for home oxygen therapy if you have symptoms and/or findings related to low oxygen levels such as pulmonary hypertension or recurring congestive heart failure due to right-sided heart failure.

  2. Be sure there is well-documented evidence of the qualifying medical condition as mentioned above in your medical file. If you are looking into how to get an oxygen tank at home, you will need to fulfill home O2 requirements and prove that you require treatment for your medical treatment at home.

  3. Obtain an arterial blood gas study. Typically, to qualify for home oxygen therapy, you must have either:
    • An arterial blood gas (PaO2) at or below 55 mm Hg or an oxygen saturation at or below 88%, taken at rest (awake)
    • An PaO2 at or below 55 mm Hg, or an oxygen saturation at or below 88%, taken during sleep for a specified duration for a patient who demonstrates a PaO2 at or above 56 mm Hg or an oxygen saturation at or above 89% while awake
    • A greater than normal fall in oxygen level during sleep (a drop in PaO2 of more than 10 mm Hg, or a decrease in oxygen saturation of more than 5%) associated with symptoms or signs reasonably attributable to low blood oxygen levels
    • A PaO2 at or below 55 mm Hg or an oxygen saturation at or below 88%, taken during exercise for a patient who demonstrates a PaO2 at or above 56 mm Hg, or an oxygen saturation at or above 89%, during the day while at rest, with improved results when oxygen is administered.
  4. Obtain a written prescription from a qualified health care professional who has recently examined you (generally within the last month). The prescription should include a diagnosis of the condition requiring the use of home oxygen, the oxygen flow rate in liters per minute and an estimate of the frequency and duration of use (for example, 3 liters per minute, 50 minutes per hour, 12 hours per day) and duration of need (for example, 6 months or lifetime).
  5. Make sure your doctor completes a Certificate of Medical Necessity and/or other forms as required by insurance indicating your diagnosis, length of need, oxygen blood gas level or pulse oximetry reading and the testing facility from which the readings were obtained, how the test was taken (room air, at rest, during exercise or while asleep), portability (if needed), liter flow prescribed, doctor’s signature and date. Make sure you know your insurance company’s requirements and, if you qualify, the medicare oxygen requirements.

Qualifying for Portable Oxygen

If you enjoy the freedom and independence that comes from using oxygen on the go, you may want to consider a portable oxygen concentrator like one of the Inogen One models. Inogen products can be covered by insurance companies, including Medicare and Medicaid, to help with payments or rental of our oxygen products. With an Inogen One, Medicare will pay for portable oxygen rental if all of the following apply to you:

  • You meet the aforementioned daytime arterial blood gas testing criteria 
  • Your doctor provides a prescription saying that you require supplemental oxygen and/or have a severe lung disease
  • Your medical documentation indicates that you are mobile in your home and would benefit from the use of a portable system
  • Alternative treatments have failed

If the above conditions apply, you meet the medicare oxygen requirements and may be able to rent an Inogen One with Medicare.

With an Inogen One Medicare rental, you will qualify for getting oxygen at home with a monthly rental of oxygen supplies. You will pay 20% of the Medicare approved amount, with the Part B deductible still applying. You will be able to rent your oxygen equipment for 36 months, after which time your supplier must continue to provide oxygen equipment and related supplies for an additional 24 months, and up to 5 years, as long as you have a medical need for oxygen. Even with state of the art equipment like the Inogen One, Medicare offers rental coverage for getting oxygen at home

Inogen at Home Woman Reading

The Inogen One: The Right Choice for Home Oxygen

An Inogen One Medicare rental can help you enjoy the benefits of an innovative portable oxygen concentrator at a reduced cost. The Inogen One can help you discover what it is like to enjoy improved freedom, mobility and independence, all while receiving your oxygen treatments. If you are concerned about how to get an oxygen tank in and out of your home or car, a portable oxygen concentrator is a great choice for you. Small, compact and lightweight, Inogen’s portable oxygen concentrators allow you to get the oxygen you need at home or on the go. If this sounds like the right choice for you, look into your Medicare oxygen requirements and find out if you can get an Inogen One Medicare rental today. Contact Inogen to find out more.

Frequently Asked Questions: Getting Oxygen At Home

Do you need a prescription for oxygen?
Yes, you do. There is a strict criteria for oxygen therapy. Your doctor must provide proof that they recently examined you, along with a detailed diagnosis, explanation of why you require supplemental oxygen, a prescription for your oxygen use, including flow rate, duration and frequency of use and duration of need. 

Are there specific Medicare oxygen requirements for an Inogen One Medicare rental?
Medicare’s requirements are the same, regardless of your oxygen delivery system. Every Medicare patient must meet the same home O2 requirements before receiving approval to rent oxygen equipment. Medicare does cover an Inogen One Medicare rental if you meet the criteria. Contact Inogen for more information. 

How much does it cost to rent an oxygen concentrator?
Costs can vary significantly depending on what kind of oxygen concentrator you want to rent, what kind of insurance coverage you have and whether or not you meet the criteria to have your rental covered by insurance. Generally speaking, renting an oxygen concentrator can cost anywhere from $35 to $225 per week, depending on your individual insurance coverage.

 

Source:
National Coverage Determination (NCD) for Home Use of Oxygen (240.2). CMS.gov. Accessed 8/24/2015.

Additional Sources
https://www.medicare.gov/coverage/oxygen-equipment-accessories

https://www.oxygenconcentratorstore.com/help-center/oxygen-rentals/how-much-does-it-cost-to-rent-a-portable-oxygen-concentrator/

By Deborah Leader RN, BSN, PHN

 

36 thoughts on “5 Steps to Qualifying for Home Oxygen Therapy”

  1. Avatar Stacy, a very concerned daughter says:

    Trying to understand the guidelines and seeking clarification. Logically, the 88% rule applies to a person with 2 lungs, with reduced capacity or normal capacity and/or CHF.
    Is there specific criteria for a person living with only One Lung, (Second removed due to cancer) operating at <30% capacity, down from 45% a year ago, along with a diagnosis of COPD and quite possibly CHF?
    For several months now, mother is now on 24hr oxygen, using portable O2 in the rehab facility when she goes anywhere outside her room, where she uses a no portable device. Sending her home again (from hospital/rehab) without portable O2, dooms her to the rest of her life being housebound. That is not Living…
    It doesn't seem that the 88% rule/standard would nor could apply…can you please provide some immediate clarification, so a request can be properly submitted to United Healthcare/Medicare? She can't afford this system out of pocket financially, and she can't afford to be housebound the rest of her life either.
    Thank you for your assistance. Hoping for some positive feedback and guidance, as the company servicing her home O2 is being much less than helpful.

  2. Avatar Anna Aloisio says:

    Does inogen accept Medicaid and Medicare. My father does receive inogen services though your company and has Medicare and private insurance right now. However, he will going into the nursing home and he will no longer have the private insurance. He will have Medicaid and Medicare. He really enjoys his portable pack and would like to continue services with your company. Do you accept Medicaid and Medicare as payment?

    1. Inogen Inogen says:

      Hi Anna, Please call 1-800-678-5572 to speak with an Oxygen Specialist. Medicare coverage varies from region to region, but an Oxygen Specialist can check your insurance over the phone and can determine whether or not your father will be covered.

  3. Avatar Frank Ciccarello says:

    Can you try to list requirement 3 in ENGLISH
    please!!!!!!

    1. Inogen Inogen says:

      Hi Frank, We apologize if the exact requirements for an ABG (Arterial Blood Gas) Study are confusing to you. What we were trying to say is there are a few different test results that meet the criteria for home oxygen therapy. If you do require and take an ABG Study, your doctor will go through your results and may be able to explain the requirements to you in person a little bit better.

  4. Avatar Sharon says:

    My daughter who is 32 who has severe Cerebral Palsy, seizure disorder and congestive heart failure . Her saturation rates falls below 88 and she has difficulty breathing. Once she is in the hospital and given oxygen and medication her rates goes up. I am unable to get a prescription for oxygen at home from the hospital or her primary doctor but I continue have to admit her to the hospital every other month. She just needs it PRN. Why is it so difficult to get oxygen at home? Why can't they write up the paper work for oxygen at home when they check her saturation rate during her hospital visit at the time it's low?

    1. Inogen Inogen says:

      Hi Sharon, In order to be prescribed long term oxygen therapy (LTOT) the patient needs to have a resting partial pressure of oxygen (PaO2) of less than 55 mmHg and an oxygen saturation level lower than 88%. For more information, please visit: https://www.inogen.com/blog/copd-and-oxygen-therapy-when-do-you-need-to-start/ and https://www.inogen.com/resources/oxygen-therapy-treatment/what-is-oxygen-therapy/

  5. Avatar Samuel Christen, MD says:

    I need portable O2 when doing light housework or traveling. Any exercise other than sitting brings on symptoms of air hunger.. This is especially true on airplane flights.
    The VA refuses to give me an exercise test, or pulmonary function tests, to check arterial blood gasses under stress, which is when I really need portable oxygen. They falsely state my symptoms would not be relieved by oxygen, but I know this to be false after O2 therapy on long flights.
    I have a compromised heart with reduced cardiac output, underwent a 4 vessel bypass in 2001. I am now 77 and rated 100% disabled by the VA for combat injuries and conditions.
    Can you help me to qualify for a benefit from the VA for portable oxygen?

    1. Inogen Inogen says:

      Hi Samuel, Please call an Oxygen Specialist at 1-800-374-9038. We can not guarantee we can help you but an Oxygen Specialist will do his or her best to assist you.

  6. Avatar Patsy Holliday says:

    My sister has breathing problems. When she has to go to the hospital they give her a breathing tube and she can breath very well. When she is discharged the hospital will not send a breathing tube home with her because they say her oxygen levels are too high. I don't understand the hospital doctor's reasoning. Can you explain??

    1. Inogen Inogen says:

      Hi Patsy,
      Thank you for writing to us. I suggest that you refer to her pulmonologist or primary care physician for their advice. Take care.

  7. Avatar Rich says:

    Hello:
    My mother has lung cancer and pulmonary embolus – she has been admitted 2x and passed walking oxygen sats test while admitted but dips to 89 and 88 while asleep. She seems more comfortable on oxygen at times when she is stressed. Is testing as an outpatient ever as an option? Are criteria different for those with complicated disease such as PE and cancer?
    Thanks
    Rich

    1. Inogen Inogen says:

      Hi Rich, Thank you for reaching out. Testing as an outpatient is an option, so I suggest she reach out for outpatient testing and nocturnal (overnight oximetry) testing. A physician could order oxygen for the PE and cancer, however Medicare is pretty specific about eligibility testing and paying for the oxygen. You could purchase the POC with a simple Rx if she doesn’t qualify through Medicare. https://www.inogen.com/blog/transient-nocturnal-desaturation/
      Hope this helps!

  8. Avatar GWENDOLYN E GADSON says:

    My church has purchased a Oxygen Tank, Can we legally get it filled with Oxygen without a prescription in the State of Virginia?

    1. Inogen Inogen says:

      Hi Gwendolyn,
      Thank you for reaching out to us.
      We do not sell oxygen tanks, nor can we provide information on the requirements regarding prescriptions for them. Please contact a local doctor in Virginia for more information on this. Our portable oxygen concentrators and stationary unit do require prescriptions. Thank you.

  9. Avatar ted trzaska says:

    I have copd and I am on oxygen at home what do I need to do to get a portable oxygen concentrator to carry with me when I go out

    1. Inogen Inogen says:

      Hi Ted, Thank you for reaching out to us. Please call us at 1-800-374-9038 and we can provide the steps in detail to you. Thank you for your interest.

  10. Avatar Venita Cullum says:

    An Inogen "specialist" is telling me I need to sign a rental agreement to get Inogen service even though the rental will be paid by Medicare and supplemental insurance. Is this correct? I have been through the O2 testing procedure 3 times and paperwork has been sent in 3 times. A deadline is approaching which means I might have to go through the procedure again! All I want to do is change suppliers. My present supplier is being paid by Medicare and the supplemental insurance.

    1. Inogen Inogen says:

      Hi Venita, Please call us at 800-695-7915 and we can look into your case for you. I am sorry that you have had to go through this 3 times and hope this is the last time.

  11. Avatar diane plymale says:

    i have cluster head aches and oxygen is only thing that helps but i can not get it because my oxygen level is 94 any suggestion how to get it filled

    1. Inogen Inogen says:

      Hi Diane,
      That sounds painful. I suggest you speak with your doctor and discuss different options.

  12. Avatar Traci Casey says:

    Hi, I have Pulmonary Hypertension and am on oxygen therapy 24/7. I have both Medicare and Medicade and was curious if an Inogen would be covered?
    Thank you

    1. Inogen Inogen says:

      HI Traci,
      Please contact us via telephone and we will run a free eligibility check for you. 1-800-695-7915

  13. Avatar Matt says:

    Just curious if this is a scam or not, We called gave all info needed and was told it was going to finance for approval, Certainly not a quick process but I specifically asked if we would be told one way or the other so we could go a different route if need be, were going on a week so; how long should we wait before calling once again to check the status? Thanks

  14. Avatar Linda says:

    I have been on oxygen for nocturnal hypopnea. I also use a CPAP. Medicare recently became my primary. I am receiving contradicting information regarding the transition. Does Medicare require any testing to document the need? I had a sleep study done July 2019. The clinic notes state there is a need for oxygen at night.

    1. Inogen Inogen says:

      Hi Linda,
      Thank you for reaching out to us. Please give us a call and we can provide you with a free Medicare eligibility check. Thank you and we look forward to hearing from you soon.

  15. Avatar James Anderson says:

    I I have been on home oxygen and portable tanks all covered by Medicare/Medicaid. How do I switch to Inogen as my supplier?

    1. Inogen Inogen says:

      Hi James,
      Thank you for your message. Please give us a call and we can provide you with a free Medicare eligibility check. We can tell you in a matter of minutes and offer you alternative solutions if Medicare won't cover your equipment.
      Talk to you soon!

  16. Avatar Donna Jackman says:

    I cannot move the transport oxygen tanks around with my two shoulders needing replaced and cannot be done because of other health issues. Please help me to get something smaller and lighter that I can handle and use when having to be out and about

    1. Inogen Inogen says:

      Hi Donna,
      Thank you for reaching out. We would be happy to try and help you. Please call us at your earliest convenience and we can explore your options with you. 1-800-695-7915.
      Thank you!

  17. Avatar Rose Marie Fermin says:

    I have a innogen one, G3 and it needs maintenance done. I cannot seem to find who can do this in the 60630 area, Chicago? Looking it up on line gives you a bunch of places to purchase but no repair. Your assistance is appreciated as I also contacted Cutomer care at 805-562-0515, only to be told they are a warehouse/manufacturer and do not have this information.

    1. Inogen Inogen says:

      Hi Rose Marie,
      Please contact us at 877-466-4364 and we can help you out. So sorry that you were given the wrong number.
      Thank you,
      Inogen

  18. Avatar Ava Sandford says:

    If I wanted to purchase a Inogen unit directly (not through insurance), do I need a prescription? I am considering this as a precaution to needing O2 for an asthma issue and not getting into the hospital due to Covid-19.

    1. Inogen Inogen says:

      Hi Ava,
      Thank you for reaching out to us. We do still require a RX even if it is a cash sale. Sorry!

  19. Avatar Don Mayhew says:

    What are the regular maintenance costs of using a G4 unit?

    1. Inogen Inogen says:

      Hi Don, Basic maintenance is cleaning the particle filters weekly, if you'd like to purchase extra filters, it is approximately $11.95.
      Output filter kit is the filter behind the cannula barb and can be changed approximately every 5 years, kit is approximately $19.95 and comes with two filters and the spanner wrench.
      The columns are expected to last 18+ months and are approximately $99.
      These estimates can fluctuate due to your environment and usage.
      If you have more questions, please call us and we can assist.

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