Responsibilities of physicians prescribing long-term oxygen therapy (LTOT)

Document the need for LTOT in the medical record*

Select a qualified oxygen equipment supplier

Complete certificate of medical necessity form, CMS 484, in the United States and specify:

1. Oxygen flow at rest, during exercise, and during sleep, where appropriate

2. Oxygen delivery systems, including:

A. Stationary unit

B. Portable or ambulatory equipment

C. Oxygen-conserving device, if desired

D. Nasal cannula or transtracheal catheter

3. Justification for portable or ambulatory oxygen, if requested

4. Verify that the supplier has correctly restated the prescription before signing

Monitor use and environment (with home oxygen supplier)

Reevaluate for possible changes in the prescription

Renew LTOT, as required

* Please see UpToDate topic on long term oxygen therapy.

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