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Medicare, CPAP Supplies and Oxygen Equipment

Medicare's Coverage of Oxygen Supplies

If you’re using Medicare to cover your oxygen, there are a few things you should know. These are outlined in the list below:
• You must have a visit with your doctor or healthcare provider and have a Rx before Medicare will cover it.
Everything billed to Medicare needs a special form called a Certificate of Medical Necessity, as well as other documents such as office visit notes or copies of test results
We cannot deliver oxygen or oxygen supplies unless with have a written order from your doctor or healthcare provider. We also have to have the documentation at the time we provide the equipment—there’s no waiting for a later date for the documentation to come through. That’s because Medicare won’t pay us if we do so. Please be patient while we collect the required documents from your doctor or healthcare provider.
Under Medicare, your oxygen therapy is paid for on a rental basis. Medicare will make 36 months of rental payments, which includes all services and accessories
You will be responsible for part of this cost—20% of the Medicare-approved amount, to be exact.
After 3 years, the rental charges stop, but the supplier must still provide oxygen, oxygen equipment and accessories until the equipment’s useful lifetime has ended—this is usually around the 5-year mark.
At the 5-year mark, you will need to get replacement equipment from the supplier.
More information regarding Medicare can be found here

CPAP Compliance

It’s important that you remain compliant if you are using CPAP equipment. Not only does it improve your overall health and well-being, it’s also required if Medicare covers your equipment. When your doctor or healthcare physician first prescribe sleep apnea therapy, in the first 90 days of treatment the following things must happen:
• You must use your machine 70% of the time during a 30 consecutive day period. This means you must use it 21 days out of a 30-day time span.
• You must use the machine for at least 4 hours during each of those 21 nights.
• If you do both of the above, you will be considered “compliant” under Medicare’s standards.
• During the second or third month of the 90-day treatment, you are required to have an office visit with your doctor or healthcare provider. During that time, the doctor or healthcare provider will document any improvements in your condition. This is a requirement if Medicare is to continue covering your CPAP therapy.
• If the data on the machine shows you are not compliant and the doctor or healthcare provider cannot document improvement to your conditions, then Medicare will no longer cover your CPAP equipment.