National Coverage Analysis (NCA) Tracking Sheet

Home Use of Oxygen to Treat Cluster Headache



Cluster headache is characterized by severe stabbing headaches usually located behind one or both eyes, often accompanied by redness and tearing of the eye, and nasal congestion. The headaches are usually more brief and intense than migraine headaches. Cluster headaches usually begin as intermittent headaches that occur over a "cluster" of several weeks, and may be followed by many months or years with no symptoms. The individual headaches that occur are often circadian, meaning that they may occur at the same time every day. An affected patient may have anywhere from one to many headaches per day. Cluster headache has an estimated prevalence of 0.1% in the general population and could affect as many as 36,000 Medicare beneficiaries. Cluster headache can persist throughout later years of life.

Oxygen administration in a health care setting has been used to treat cluster headache. Medicare currently has a NCD for Home Use of Oxygen (240.2) that provides for coverage of home oxygen under specific conditions when the patient has significant chronic stable hypoxemia. The current policy has been in effect since March 20, 2006. The NCD does not address the home use of oxygen for the treatment of cluster headache.

Formal and informal requestors have approached CMS and have asked us to review the evidence and reconsider the NCD to provide national coverage for the home use of oxygen to treat cluster headache. The scope of this review does not include any consideration of hyperbaric oxygen (HBO) for any indication.

Benefit Category

Durable Medical Equipment

Requestor Information

Requestor NameRequestor Letter
Fred Sheftell, MD, President, American Headache Society N/A
Robert C. Griggs, MD, FAAN, President, American Academy of Neurology N/A

Important Dates

Formal Request Accepted and Review Initiated
Expected NCA Completion Date
Public Comment Period
04/09/2010 - 05/09/2010
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
10/08/2010 - 11/07/2010
Decision Memo Released
Comments for this NCA
View Public Comments


Lead Analysts
Jean Stiller, MA
Lead Medical Officers
Ross Brechner, MD, MS (Stat.), MPH

Actions Taken

April 9, 2010

CMS opens NCD review. 30-day public comment period begins.

October 8, 2010

CMS posts the proposed decision memorandum and begins a second 30-day public comment period.

To submit a comment, please use the orange COMMENT button located at the top of the page.

January 4, 2011

CMS posts the decision memorandum.