[Equipment] Will medicare pay for my oxygen condenser based on this result?

[ThinMountainAir]

Even though my AHI on CPAP is great, my doctor ordered an overnight oximetry. Based on the results, she Rx’ed supplemental oxygen (one LPM I think). I’ll be getting an oxygen condenser soon. There are several sites, e.g., ResMed, with good layman’s language explanations of the Medicaid reimbursement rules but I’m having trouble comparing the rules to my oximetry results.  If anyone can give their best guess as to whether Medicare will pay for my condenser, I’d appreciate it. (Aside from Medicare, I hope the oxygen helps because CPAP alone sure isn’t working! ! But that’s for later. I want to compile some more OSCAR data before I post that plea for help.) 

   

[Gideon]

I believe No as you are on CPAP and CPAP improves data. And I believe the Medicare standard is 88% and that data shows 89%>

If that dataset is with a CPAP then your doc may be able to argue and convince Medicare to approve supplemental oxygen.

[Sleeprider]

All you can do is have your doctor submit the results with his recommendation and a prescription. This test shows you were using PAP without supplemental oxygen and had over 43 minutes at less than 89% SpO2 with a 33 minute sustained desaturation. I believe that more than meets criteria. as demonstrating a medical need for supplemental oxygen. If you want to learn more about how an oxygen bleed works with CPAP we have a wiki with some good information. Supplemental oxygen increases the fraction of inspired oxygen from atmospheric levels of about 20% to a more enriched mixture to correct desaturation. http://www.apneaboard.com/wiki/index.php..._with_CPAP

We can look at your CPAP data to see if there are opportunities for optimization, and considering these results, you may want to purchase a pulse oximeter to use to further document your problem.

[ThinMountainAir]

My oxygen condenser arrived today. Because I had read the wiki you suggested about it I was able to help the DME person set it up. I hope my insurance pays for it but if it will rid me of this meddlesome fatigue I’d gladly pay for it myself (though I would prefer not to).

I’m glad that in your response you added “I believe that more than meets criteria as demonstrating a medical need for supplemental oxygen.”  I  wasn’t sure how seriously to take the Rx for oxygen supplementation. I do now. 

Regarding having the forum look at my data to maybe find opportunities for optimization. Yes, I’d really like to do that once I get some more consistent data. Already I’ve made some small but beneficial tweaks based on things I’ve learned from this forum, e.g., balancing EPR and pressure settings.

[ThinMountainAir]

I learned today that Medicare is covering the cost of my oxygen condenser.

[newb]

Indeed Medicare, and other insurance companies, have stupidly adopted 88% cut off.
There is no medical justification for that in 2022.
COVID-19 patients are put on oxygen when they drop to 92%.
So why the 88% is good for anybody?
Ask your doctor hard questions and ask for his help.
The medical need is not at 88%, never really was, it is today at 92% as proved by thousands of COVID-19 hospitalized people.