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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that a portable oxygen system is covered if the beneficiary is mobile within the home and the 
qualifying blood gas study was performed while at rest (awake) or during exercise. If the only qualifying blood 
gas study was performed during sleep, portable oxygen will be denied as not reasonable and necessary. If 
coverage criteria are met, a portable oxygen system is usually separately payable in addition to the stationary 
system. If a portable oxygen system is covered, the supplier must provide whatever quantity of oxygen the 
beneficiary uses; Medicares reimbursement is the same, regardless of the quantity of oxygen dispensed. You 
can find this rule in the Local Coverage Determination (LCD) L33797. 
 
The rules say that the reasonable useful lifetime for oxygen equipment is 5 years. The RUL is not based on the 
chronological age of the equipment. It starts on the initial date of service and runs for 5 years from that date. 
RUL also does not take into account exchanges of equipment, new suppliers, or changes of modality 
(concentrator, gaseous, liquid). Stationary and portable oxygen equipment is often provided at the same time 
therefore the RUL for both items run concurrently. When the RUL of a beneficiarys portable oxygen 
equipment differs from the RUL of the beneficiarys stationary oxygen equipment, the RUL of the stationary 
oxygen equipment shall govern the application of RUL-based rules and processes for both types, stationary and 
portable, of oxygen equipment. 
 
Reimbursement for oxygen equipment is limited to 36 monthly rental payments. Payment for accessories (e.g., 
cannula, tubing, etc.), delivery, back-up equipment, maintenance, and repairs is included in the rental 
allowance. Payment for oxygen contents (stationary and/or portable) is included in the allowance for stationary 
equipment (E0424, E0439, E1390, E1391). 
 
There is no further payment for oxygen equipment during the 5-year reasonable useful lifetime (RUL) of the 
equipment after 36 rental payments have been made. If use of portable equipment (E0431, E0433, E0434, 
E1392, K0738) begins after the use of stationary equipment begins, payment for the portable equipment can 
continue after payment for the stationary equipment ends until 36 rental payments have been made for the 
portable equipment. 
 
 
 
 
 
 The supplier who provided the equipment during the 36th rental month is required to continue to provide the 
equipment, accessories, contents (if applicable), maintenance, and repair of the oxygen equipment during the 5 
year reasonable useful lifetime of the equipment. At any time after the end of the 5-year reasonable useful 
lifetime for oxygen equipment, the beneficiary may elect to receive new equipment, thus beginning a new 36-
month rental period. you can find this rule in the Local Coverage Article Oxygen and Oxygen Equipment - 
Policy Article A52514. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.