Does Medicare Cover Oxygen for COPD?

More than 12 million Americans have been diagnosed with chronic obstructive pulmonary disease (COPD), with millions more likely undiagnosed. For many, especially in advanced stages, supplemental oxygen therapy is essential. It can improve quality of life and prevent complications like hypoxemia—but navigating Medicare coverage for oxygen and equipment often adds financial stress.

So, does Medicare cover oxygen therapy for COPD? The short answer is yes—but only if specific medical requirements are met. This guide breaks down what’s covered, how to qualify, and what to do if your claim is denied.

Understanding Medicare Coverage for Oxygen Therapy

Medicare coverage for oxygen therapy varies depending on how and where the oxygen is administered. Understanding which part of Medicare pays for which services is key to minimizing your out-of-pocket costs and ensuring timely access to needed equipment.

Part A, Part B, and Medicare Advantage

Medicare Part A covers oxygen therapy provided in an inpatient setting, such as during a hospital stay or skilled nursing facility admission.

Medicare Part B provides coverage for oxygen therapy at home as durable medical equipment (DME), including oxygen concentrators, tanks, tubing, and masks.

Medicare Advantage (Part C) plans are required to offer at least the same coverage as Parts A and B, but often include additional rules, network restrictions, or prior authorization steps.

To qualify for any Medicare-covered oxygen therapy, a few core requirements must be met:

• The patient must be enrolled in Medicare.
• The oxygen must be prescribed by a Medicare-enrolled doctor.
• The prescription must include medical necessity documentation, including qualifying oxygen saturation test results and supporting clinical notes.

Understanding these core elements lays the foundation for approval. But meeting these basic criteria is only the beginning.

Medicare Requirements for Home Oxygen Therapy Approval

Medicare doesn't approve oxygen therapy lightly. There are strict requirements that help ensure oxygen is used appropriately and that resources are reserved for patients with medical necessity.

Clinical documentation requirements

To ensure appropriate use and control costs, Medicare has a detailed set of criteria that must be met before home oxygen therapy is approved:

• Severe lung disease (such as COPD or cor pulmonale)
• Arterial PO₂ ≤ 55 mm Hg or oxygen saturation ≤ 88% on room air (based on arterial blood gas or pulse oximetry test)
• Potential health improvement from oxygen therapy
• Failure of alternative therapies

These clinical factors must be clearly documented and supported by testing data.

Face-to-face medical evaluation

A recent in-person examination must document medical necessity.

Recertification

For Group II patients, recertification is required after 90 days. For Group I patients, recertification is required after 12 months. Subsequent recertifications are required annually to continue coverage, with documentation supporting ongoing medical necessity.

Certificate of Medical Necessity (CMN)

The Certificate of Medical Necessity (CMN) is essential for approval and must include detailed information such as arterial blood gas (ABG) or oxygen saturation test results, prescribed oxygen flow rate, duration of use, and evidence of medical necessity.

• Must include detailed testing data, flow rates (e.g., minimum liter flow of 0.5 L/min for pediatric patients), and evidence of need.
• CMNs often get denied for incomplete documentation or missing test results.

Flow rate & usage expectations

The required oxygen flow rate and timing can also affect eligibility.

• Patients typically must use oxygen for 24-hour continuous oxygen therapy or specific durations (e.g., nocturnal oxygen therapy, exercise-induced desaturation).
• Medicare distinguishes between continuous flow and pulse dose oxygen delivery, which can affect eligibility.

Together, these requirements help Medicare determine if home oxygen therapy is justified—and what equipment qualifies for coverage.

Learn more about Medicare's requirements for oxygen equipment and accessories at Medicare.gov

Different Types of Oxygen Equipment Covered by Medicare

Once you qualify, Medicare Part B offers coverage for a wide variety of oxygen systems. Each has its own features, costs, and maintenance needs.

Stationary oxygen concentrators

• The most common home-based device.
• Medicare usually rents the equipment (rather than purchasing it).
• Routine maintenance and servicing are included in the monthly rental fee.

These are often ideal for patients who need oxygen primarily at home.

Compressed gas systems

• Include tanks in varying sizes.
• Medicare covers oxygen fills, regulators, and specialized tubing under DME.
• Tanks may require backup systems like smaller portable tanks.

This setup is suitable for patients who need flexibility and occasional mobility.

Liquid oxygen systems

• Less common due to higher costs.
• May be covered if there's documented need for higher flow rates.
• Include refill delivery services, but not all suppliers offer this.

Patients with higher oxygen demands or mobility needs may benefit from this system—if it’s available in their area.

Portable oxygen systems

• Standard portable tanks are covered under Medicare.
• Include options for ambulatory patients who qualify based on activity level documentation and ambulatory oxygen testing.

Portable tanks can offer limited mobility but require re-fills and regular servicing.

Accessories and supplies

• Medicare covers nasal cannulas, masks, humidifiers (if medically necessary), and tubing.
• Supplies are eligible for replacement every 30 to 90 days, depending on type.

Ongoing maintenance is part of coverage, as long as eligibility is maintained.

How to Get Medicare to Pay for Portable Oxygen Concentrators

Portable oxygen concentrators (POCs) are one of the most misunderstood parts of Medicare oxygen coverage. These lightweight, battery-powered devices are useful for active patients—but they’re not automatically covered.

Documentation and strategy tips

Medicare typically does not cover portable oxygen concentrators (POCs) because they are considered luxury or convenience items. However, coverage may be possible if documentation demonstrates medical necessity, such as significant oxygen desaturation during exertion and a clinical need for mobility outside the home.

While Medicare typically covers standard portable oxygen tanks, battery-powered concentrators require stricter documentation and approval is not guaranteed.

To improve the chance of approval:

• Ensure documentation shows:
  • Patient’s active lifestyle or work requirement
  • Need for frequent travel
  • Medical necessity for mobility, especially with oxygen desaturation during exertion
• Work closely with your physician to use correct coding:
  • Include terms like ambulatory oxygen need, exercise-induced desaturation, or overnight oximetry study in the prescription.
  • Highlight any in-flight oxygen arrangements or specific oxygen delivery system needs.

If Medicare denies coverage

• Consider rental options through private vendors
• Explore Medicare Advantage plans, some of which may include POC coverage
• Check Medigap policies for supplemental coverage support

Persistence and the right documentation can make a difference—even when initial approval is denied.

Medicare’s Oxygen Equipment Rental Process

Once approved, oxygen equipment is rented, not purchased, through a structured timeline. This process ensures continued access while controlling long-term costs.

Initial 36-month rental period

• Covers all maintenance, servicing, and accessories
• Monthly rental includes necessary supplies
• You must continue to meet eligibility to receive oxygen
• After the 36-month rental period, Medicare no longer pays rental fees, but the supplier is required to continue providing maintenance and supplies for an additional 24 months, up to a total of 60 months, as long as the equipment remains medically necessary.

24-month supplier obligation period (Months 37–60)

• Suppliers must continue to maintain and service equipment without additional rental charges
• Accessories and supplies are still covered

Post-5-year period

• New Certificate of Medical Necessity required
• New rental contract may begin
• Consider supplier quality and coverage before renewing

This rental model helps streamline services, but requires staying proactive about recertification and supplier communication.

You can also review Medicare’s official DME coverage page for more information on how equipment rentals work under Part B.

Out-of-Pocket Costs for Medicare Oxygen Coverage

Understanding costs is essential for planning ahead. While Medicare offers strong support, there are still expenses patients may face.

Original Medicare (Parts A and B)

• As of 2025, the Medicare Part B deductible is $257. After meeting the deductible, beneficiaries typically pay 20% of the Medicare-approved amount for oxygen equipment and supplies.
• You’re responsible for 20% coinsurance for oxygen equipment and supplies
• Monthly costs vary depending on the specific equipment and supplier, but beneficiaries are responsible for 20% of the Medicare-approved amount after meeting the Part B deductible.

Additional costs may include:

• Upgraded equipment or accessories (e.g., travel tanks, humidifiers not deemed medically necessary)
• Non-covered items, such as POCs or extra tanks for travel
• Out-of-network supplier fees under some Advantage plans

Medicare Supplement (Medigap) plans

• May cover the 20% coinsurance
• Some plans also cover the Part B deductible
• Compare Medigap options here

These plans can help reduce financial strain for those who need long-term oxygen therapy.

Medicare Advantage and Oxygen Therapy

Medicare Advantage plans offer an alternative to Original Medicare and often come with different structures and benefits.

Key differences to consider

Medicare Advantage plans must provide equivalent coverage to Original Medicare, but may:

• Offer additional benefits (like POC coverage)
• Require prior authorization or use network-limited suppliers
• Impose copayment-based cost models instead of coinsurance

To choose the right plan:

• Review plan formularies and DME rules
• Ask:
  • Does this plan cover POCs?
  • What suppliers are in-network?
  • What’s the process for prior approval?

COPD patients should carefully review oxygen coverage details before enrolling to avoid surprise costs or access issues.

Navigating Medicare’s Oxygen Coverage: Denials, Upgrades, and Travel

Even if you meet eligibility requirements, things can still go wrong. Understanding how to handle denials or changes in oxygen needs can make a big difference.

Common reasons for denial

Coverage can be denied for:

• Incomplete or outdated testing
• CMNs missing required documentation
• Lack of proof of medical necessity

Appeal process

• Must be filed within 120 days
• Include new test results, practitioner progress notes, and pulse oximetry values
• Ask your doctor to reference relevant National Coverage Determination (NCD) codes from CMS.

Upgrades or equipment changes

• Must submit a new prescription with supporting test data
• Supplier must confirm Medicare guidelines are met

Travel considerations

• Medicare does not cover oxygen equipment for use during travel or flights. Beneficiaries are responsible for arranging and covering the cost of oxygen needed while traveling or flying. However, some suppliers may offer rental options for portable oxygen concentrators suitable for travel.
• If you need oxygen while traveling or flying, you’ll need to make arrangements and pay out of pocket.
• Consider renting a portable concentrator from a private vendor or working with your physician to explore short-term solutions.

Planning ahead can help avoid major disruptions when traveling or changing oxygen setups.

Working with Oxygen Suppliers who Accept Medicare

Your choice of supplier can have a major impact on your experience. Not all suppliers are the same, and working with the right one can smooth the process.

Finding a supplier

• Use Medicare’s Supplier Directory
• Confirm the supplier accepts assignment (billing Medicare directly)

Ask:

• Do you service my ZIP code?
• What are your delivery times?
• Do you provide 24/7 emergency support?

Supplier responsibilities

• Equipment upkeep and replacement
• Patient education on usage and safety
• Recertification reminders

Good suppliers don’t just deliver equipment—they support your treatment journey.

How a Solace Patient Advocate Can Help

Navigating Medicare’s oxygen rules can be overwhelming, especially if you're dealing with COPD complications.

Solace Patient Advocates can:

• Help you gather and submit required medical documentation
• Assist with identifying Medicare-approved suppliers
• Support you in cases of coverage denial or appeal

They also work with your healthcare team to:

• Coordinate treatment planning
• Identify barriers to coverage
• Make sure you’re not paying out of pocket for covered services

If you're unsure where to start, a patient advocate can make the process much more manageable.

Frequently Asked Questions About Medicare-Covered Home Oxygen Therapy

1. What lab tests are used to qualify for home oxygen therapy?

To qualify, you’ll typically need an arterial blood gas (ABG) test or a pulse oximetry reading taken on room air. Medicare looks for a partial pressure of oxygen (PO₂) ≤ 55 mm Hg or an oxygen saturation ≤ 88%. These saturation measurements must reflect your baseline—not while receiving oxygen.

2. What documentation is needed to show medical necessity?

You’ll need a signed Certificate of Medical Necessity (CMN) along with your qualifying test results. Supporting documentation should include practitioner progress notes, evidence of hypoxemia, and detailed oxygen usage expectations. Use of oximetry studies is common for nocturnal or exertional oxygen therapy.

3. Are oxygen requirements different for children and infants?

Yes. Pediatric patients must meet age-adjusted criteria, including specific arterial oxygen saturation levels and clinical indications of hypoxemia. The required oxygen flow rate and other parameters should be determined based on the child's medical condition and physician's assessment.

4. What happens if I need oxygen therapy at night only?

Medicare allows for nocturnal oxygen therapy if you have nocturnal hypoventilation or conditions like obstructive sleep apnea (OSA) that require oxygen in addition to a device like CPAP or BiPAP. Your doctor must document these needs and support them with an overnight oximetry study.

5. Can I get oxygen covered for cluster headaches or rare conditions?

It’s possible, but more complex. Conditions like cluster headaches, erythrocythemia, or pulmonary hypertension require highly specific clinical justification and often need documentation through the National Coverage Determination (NCD) process.

6. What are the typical approval timeframes for home oxygen?

Initial approvals often last three to six months depending on whether you're classified under Group I or Group II criteria. After that, recertification is required at one-year intervals. Providers may request renewal using updated pulse oximetry or arterial blood gas data.

7. Which HCPC codes or modifiers apply to oxygen equipment?

Medicare uses HCPC codes like E1390 (oxygen concentrator) and others to classify DME. Make sure your doctor uses the correct codes and indicates oxygen delivery systems (e.g., stationary vs. portable). Some codes are tied to prior approval requirements or modifier conditions like PRN oxygen needs.

8. What’s the difference between liquid oxygen, gas tanks, and concentrators?

Oxygen concentrators are stationary machines covered on a rental basis. Compressed gas systems include refillable tanks and may require a compressed gas backup system. Liquid oxygen systems, often based on cryogenic technology, are less common but can offer higher flow rates for qualifying patients.

9. Will Medicare cover in-flight oxygen or travel arrangements?

Not usually. Medicare doesn’t cover in-flight oxygen arrangements or services provided outside your home supplier area. You may need to rent equipment privately or coordinate with airlines. In some cases, a documented need for frequent travel can support portable oxygen approvals.

10. What should I ask my supplier about long-term support?

Ask about regulators, cannula or catheter replacements, and their process for competitive bidding (which can affect costs and coverage). Good suppliers also provide specialized tubing, ensure timely oxygen fills, and help track when documentation needs renewal.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

Recommended Reading:

• How is COPD Diagnosed? Tests, Criteria, and What to Expect
• What are the 4 Stages of COPD?
• Is COPD Contagious? Myths and Misinformation
• Is COPD a Disability?