Home Use of Oxygen and Home Oxygen Use to Treat Cluster Headaches

CMS NCA document | source_status=Closed | review_type=2nd Recon | public_comment_open=False | document_id=CAG-00296R2

The Centers for Medicare & Medicaid Services (CMS) is finalizing changes to two separate, but medically related, National Coverage Determinations (NCDs). Given new information in the peer-reviewed medical literature, we are removing the NCD for Home Oxygen Use to Treat Cluster Headache (CH) (240.2.2). We are also revising the NCD for Home Use of Oxygen (240.2). We summarize these changes below and fully explain our rationale in the Analysis section of this NCD decision memorandum. CMS is removing NCD 240.2.2 in the Medicare NCD Manual, ending coverage with evidence development (CED), and allowing the Medicare Administrative Contractors (MACs) to make coverage determinations regarding the use of home oxygen and oxygen equipment for CH. CMS also is modifying NCD 240.2, Home Use of Oxygen, in the Medicare NCD Manual to expand patient access to oxygen and oxygen equipment in the home, and to permit contractors to cover the use of home oxygen and oxygen equipment in order to treat CH and other acute conditions. The scope of this decision does not include any consideration of Home Use of Oxygen in Approved Clinical Trials, identified in section 240.2.1 of the NCD Manual. Additionally, the scope of the decision does not include any consideration of hyperbaric oxygen for any indication, currently identified in section 20.29 of the NCD Manual. See Appendices B and C for the expected NCD Manual language. CMS sought comments on our proposed decisions consistent with the public process established by §1862(l) of the Social Security Act. We are responding to public comments in this final decision memorandum.