Medicare Compliance & Reimbursement

If you've been battling your carriers about coverage for home oxygen therapy for Part B beneficiaries with cluster headaches (CH), CMS has some news for you.

On Jan. 14, CMS issued Transmittal 130, which says, "After careful reconsideration, effective for claims with dates of service on and after January 4, 2011, Medicare will allow for coverage of home use of oxygen to treat Medicare beneficiaries diagnosed with CH when beneficiaries are enrolled in clinical studies that are approved by CMS for the purpose of gaining further evidence."

Previously, CMS covered home oxygen therapy for patients diagnosed with significant hypoxemia in conjunction with other health conditions, but last April, the American Headache Society and the American Academy of Neurology asked CMS to consider adding CH to the list of acceptable diagnoses.

Patients enrolled in Medicare-approved clinical studies with the following ICD-9 codes may qualify for the benefit:

• 339.00 -- Cluster headache syndrome unspecified
• 339.01 -- Cluster headache episodic
• 339.02 -- Cluster headache, chronic

The bad news: Unfortunately, CH patients who aren't enrolled in clinical trials are still not eligible for home oxygen therapy coverage, according to the memo.

To read the CMS Transmittal, visit www.cms.gov/transmittals/downloads/R130NCD.pdf.