Medicare’s Coverage of Respiratory Treatments

Medicare Part A and Part B, collectively called Original Medicare, will help pay for respiratory treatments and rehab for beneficiaries with moderate to severe pulmonary disease. Covered treatments may include oxygen therapy and lifestyle counseling. Medicare Advantage (Part C), an alternative to Original Medicare, could include extra coverage for medications and inhalers.

Lindsey Crossmier, writer for RetireGuide
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APA Crossmier, L. (2022, April 15). Medicare’s Coverage of Respiratory Treatments. RetireGuide.com. Retrieved May 19, 2022, from https://www.retireguide.com/medicare/treatments/respiratory/

MLA Crossmier, Lindsey. "Medicare’s Coverage of Respiratory Treatments." RetireGuide.com, 15 Apr 2022, https://www.retireguide.com/medicare/treatments/respiratory/.

Chicago Crossmier, Lindsey. "Medicare’s Coverage of Respiratory Treatments." RetireGuide.com. Last modified April 15, 2022. https://www.retireguide.com/medicare/treatments/respiratory/.

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Which Respiratory Treatments Does Medicare Cover?

Original Medicare covers pulmonary treatments for respiratory disorders such as chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA).

COPD is a group of disorders that cause breathing problems. Asthma, chronic bronchitis and emphysema are all diseases that fall under COPD. Obstructive sleep apnea (OSA) is a sleep-related breathing disorder.

Medicare may cover respiratory therapy, pulmonary rehabilitation, Continuous Positive Airway Pressure (CPAP) therapy, and nebulizers to treat these disorders. You may also qualify for tobacco prevention counseling and sleep tests and devices through Medicare.

If you are between the ages of 55 and 77, asymptomatic and have smoked an average of one pack per day for 20 years, Medicare Part B will pay for a lung cancer screening with an order from your doctor. Medicare also covers two different pneumonia vaccines.

Medicare Coverage of Respiratory Therapy

For Original Medicare to cover your respiratory therapy sessions, your doctor must deem them medically necessary, and your doctor or respiratory therapist must document the sessions. The documentation must state that the services require the skills of a licensed respiratory therapist.

Part B will cover 80% of the approved treatment costs once you have met your deductible. In 2022 the Part B deductible is $233.

Respiratory Therapy Services Covered Under Medicare
Type of Respiratory Care Service
Examples
Application techniques to support oxygenation and ventilation in an acute illnessEstablish or maintain an artificial airway; ventilatory therapy; precise delivery of oxygen concentrations; help with removing secretions from pulmonary tree
Bronchial hygiene therapyDeep breathing and coughing exercises; intermittent positive pressure breathing (IPPB); postural drainage; chest percussion/vibration; nasotracheal/endotracheal suctioning
Diagnostic tests for evaluation by a physicianPulmonary function test (PFT); spirometry; blood gas analyses
Pulmonary rehabilitation techniquesExercise conditioning; breathing retraining; patient education

Covered respiratory services also include the therapeutic use and monitoring of medicinal gases, pharmacologically active mists and aerosols, and equipment like resuscitators and ventilators. Medicare may also pay for a periodic assessment to gauge the effectiveness of a patient’s respiratory therapy services.

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Medicare Coverage of Pulmonary Rehabilitation

If you have been diagnosed with moderate to severe chronic obstructive pulmonary disease (COPD), Medicare Part B will pay for a comprehensive pulmonary rehabilitation program to help you breathe easier, regain your strength and live more freely.

You can receive rehab services in a doctor’s office or in a hospital outpatient facility. Your out-of-pocket costs will be different depending on the venue you choose.

If you get your rehab in a doctor’s office, Medicare will cover 80% of the approved amount. You will need to meet your Part B deductible before Medicare will pay its portion.
If you get your rehab in a hospital outpatient facility, you will owe your Part B deductible — if you haven’t paid it already — the 20% Medicare doesn’t cover and a hospital copayment per session.

Important Update
As of Jan. 1, 2022, you can also receive pulmonary rehabilitation under your Original Medicare plan if you've had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least four weeks.
Source: Medicare.gov

Medicare will pay for up to two 60-minute sessions per day, for a maximum of 36 sessions over 36 weeks. If your condition is severe, your doctor could approve you for up to 72 sessions.

The doctor who treats your respiratory disease will need to provide a referral for pulmonary rehabilitation for Medicare to cover it.

Medicare Coverage of Respiratory Medications, Inhalers and Nebulizers

If your doctor prescribes a nebulizer for use in your home, Medicare Part B will help cover the cost of the nebulizer as DME.

Original Medicare does not pay for most outpatient prescription drugs or over-the-counter medications. But Medicare Part B will pay for some medicines used in nebulizers.

For example, if you have asthma or emphysema, Medicare will pay for albuterol, a drug commonly used with a nebulizer.

Part D, which is optional coverage you can buy separately from Parts A and B, typically covers pulmonary treatment medications, such as bronchodilator inhalers or antibiotics.

Medicare Coverage of Oxygen Equipment and Accessories

If your doctor prescribes oxygen equipment and accessories for use in your home, Medicare Part B will help pay for you to rent the necessary items as durable medical equipment, or DME.

Once you’ve met your Part B deductible, you will owe only 20% of the Medicare-approved amount; Medicare will take care of the rest of the cost.

As long as you have a medical need for oxygen and have Medicare, your supplier must provide equipment and supplies for up to five years.

Your monthly rental payments will cover your:
  • Oxygen equipment
  • Oxygen contents
  • Oxygen machine maintenance, servicing and repairs
  • Tubing or mouthpiece

You have the option to own your own equipment, but you must meet certain conditions for Medicare to help pay for systems that provide oxygen, containers that store oxygen, and tubing and related supplies.

Your doctor must say that you either have a severe lung disease or aren’t getting enough oxygen and that you might get better with oxygen therapy. Your arterial blood gas level must fall within a certain range, and you must have tried other remedies but failed to improve.

Humidifiers

Medicare may also pay for a humidifier when it’s used with your oxygen machine.

Although Medicare doesn’t usually cover humidifiers, it will cover oxygen humidifiers when used with certain covered DME, such as CPAP devices, respiratory devices or oxygen equipment.

Did You Know?
Usually, Medicare beneficiaries pay 100% for humidifiers, room heaters, dehumidifiers or electric air cleaners. But Medicare will pay 80% of the approved amount to buy or rent a humidifier if it’s used with a respiratory assist device or a CPAP device.
Source: CMS

In fact, your monthly fee for your oxygen equipment will include the cost of an oxygen humidifier if it’s medically necessary.

Medicare's Coverage of Postural Drainage and Pulmonary Exercises

Medicare will pay for postural drainage procedures and pulmonary exercises when provided by a physical therapist or a respiratory therapist as part of your physician’s treatment plan.

Postural drainage is an exercise that can help drain fluid and mucus from your lungs if you have a condition such as pulmonary edema, or lung congestion.

This treatment is 80% covered once you meet your Part B deductible. If your lungs are swollen and breathing is painful, this exercise could ease your discomfort.

Other pulmonary exercises include different types of breathing such as deep breathing, pursed lip and diaphragmatic. A medical professional can teach you how to do these breathing exercises properly.

Last Modified: April 15, 2022

16 Cited Research Articles

  1. National Library of Medicine. (2022, February 18). Lung disease. Retrieved from https://medlineplus.gov/ency/article/000066.htm
  2. National Library of Medicine. (2022, February 18). Postural drainage. Retrieved from https://medlineplus.gov/ency/patientinstructions/000051.htm
  3. National Library of Medicine. (2021, November 18). Pulmonary Rehabilitation. Retrieved from https://medlineplus.gov/pulmonaryrehabilitation.html
  4. Centers for Medicare and Medicaid Services. (2021, July 22). Respiratory Therapy (Respiratory Care). Retrieved from https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34430
  5. World Health Organization. (2021, June 21). Chronic obstructive pulmonary disease (COPD). Retrieved from https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
  6. West Virginia University. (2016, October 5). Why are respiratory therapy and pulmonary rehabilitation important? Retrieved from https://www.hsc.wvu.edu/news/story?headline=why-are-respiratory-therapy-and-pulmonary-rehabilitation-important
  7. Ozmen, I et al. (2018, September 13). Pulmonary Rehabilitation Reduces Emergency Admission and Hospitalization Rates of Patients with Chronic Respiratory Diseases. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196907/
  8. Centers for Medicare and Medicaid Services. (September 1988). Postural Drainage Procedures and Pulmonary Exercises. Retrieved from https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=17&ncdver=1&DocID=240.7&bc=gAAAABAAAAAA
  9. Medicare.gov. (n.d.). Pulmonary rehabilitation programs. Retrieved from https://www.medicare.gov/coverage/pulmonary-rehabilitation-programs
  10. Medicare.gov. (n.d.). Continuous Positive Airway Pressure devices, accessories, & therapy. Retrieved from https://www.medicare.gov/coverage/continuous-positive-airway-pressure-devices
  11. Medicare.gov. (n.d.). Humidifiers. Retrieved from https://www.medicare.gov/coverage/humidifiers
  12. Medicare.gov. (n.d.). Lung cancer screenings. Retrieved from https://www.medicare.gov/coverage/lung-cancer-screenings
  13. Medicare.gov. (n.d.). Nebulizers & nebulizer medications. Retrieved from https://www.medicare.gov/coverage/nebulizers-nebulizer-medications
  14. Medicare.gov. (n.d.). Oxygen equipment & accessories. Retrieved from https://www.medicare.gov/coverage/oxygen-equipment-accessories
  15. National Heart, Lung and Blood Institute. (n.d.). Working together to reduce the burden of COPD. Retrieved from https://www.nhlbi.nih.gov/health-topics/education-and-awareness/COPD-national-action-plan
  16. University of Maryland Medical Center. (n.d.). Breathing Exercises for COPD. Retrieved from https://www.umms.org/bwmc/health-services/lung-health/copd/treatment/breathing-exercises