AARC 2026 Legislative Priorities 

More than 1.5 million Medicare beneficiaries depend on supplemental oxygen to manage chronic lung diseases such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, bronchiectasis, pulmonary hypertension, and Alpha-1 Antitrypsin Deficiency. 

For many patients, oxygen therapy is not simply equipment—it is a life sustaining treatment that enables them to remain active, avoid hospitalization, and maintain independence. 

However, the current Medicare payment system often fails to support patient-centered oxygen care.

Current Medicare policy: 

• Treats oxygen primarily as durable medical equipment rather than a comprehensive clinical service. 
• Does not adequately recognize the ongoing clinical management required for oxygen therapy. 
• Has reduced access to liquid oxygen for patients with high-flow or ambulatory needs. 
• Creates inconsistent documentation and administrative burdens. 
• Limits patient choice and flexibility. 

• Remove oxygen equipment from Medicare’s Competitive Bidding Program. 
• Establish a statutory respiratory therapist service component for oxygen management. 
• Improve access to liquid oxygen for patients with documented medical necessity. 
• Modernize documentation requirements. 
• Strengthen program integrity through standardized documentation and fraud prevention. 
• Improve patient protections and continuity of care. 

Respiratory therapists provide services that extend well beyond equipment delivery, including: 

• Comprehensive oxygen assessments. 
• Oxygen titration. 
• Patient and caregiver education. 
• Safety counseling. 
• Equipment selection. 
• Home follow-up. 
• Monitoring adherence. 
• Preventing avoidable hospitalizations. 

Recognizing these professional services supports higher-quality care and more efficient use of Medicare resources. 

Please co-sponsor the Supplemental Oxygen Access Reform (SOAR) Act (H.R. 2902 / S. 1406) and support its advancement through the legislative process. 

Key Talking Points 

• Oxygen is a therapy—not simply medical equipment. 
• Patients deserve access to the oxygen modality that best meets their medical needs. 
• Respiratory therapists improve safety, adherence, and outcomes. 
• Modernizing oxygen policy supports patient-centered care while strengthening Medicare program integrity. 

Healthcare is increasingly shifting toward prevention, chronic disease management, and community-based care. Respiratory therapists possess specialized expertise in managing chronic respiratory diseases, yet Medicare currently lacks a comprehensive mechanism to recognize and reimburse many of these professional services outside traditional hospital settings. 

Expanding access to respiratory therapist services can help improve care coordination, reduce avoidable hospitalizations, and support patients with chronic respiratory conditions. 

In addition, chronic respiratory diseases such as COPD, asthma, pulmonary fibrosis, and Alpha-1 Antitrypsin Deficiency affect millions of Medicare beneficiaries.

Tobacco cessation counseling remains one of the most effective and cost-efficient interventions available to reduce disease progression and healthcare costs.

Respiratory therapists are highly trained specialists who already provide these services in clinical practice but cannot bill Medicare directly for them.

Medicare currently covers these services; the AIR Act simply allows qualified respiratory therapists to furnish and bill for them directly.

The AIR Act would help expand access to respiratory therapist services in areas such as: 

• COPD management 
• Asthma education 
• Home oxygen evaluation 
• Tobacco treatment 
• Pulmonary rehabilitation 
• Sleep-disordered breathing 
• Hospital-at-Home 
• Remote patient monitoring 
• Transitional care 
• Rural health 

The legislation would: 

• Improve access to preventative respiratory care 
• Support physician-led team-based care
• Advances value-based care and chronic disease prevention
• Increase practice efficiency
• Expand access in rural and underserved communities.
• Improve patient outcomes
• Supports seniors and individuals with chronic lung disease

For Medicare Part B, the national average reimbursement for tobacco cessation counseling remains relatively modest:

Recent Medicare fee schedule data indicate national average payments of roughly $17 for 99406 and $33 for 99407, although actual payment varies by locality due to Geographic Practice Cost Indices (GPCIs).

Estimated Annual Revenue Potential

Because Medicare covers up to 8 cessation counseling sessions per beneficiary per year:

• 8 × 99406 ≈ $136 per patient annually
• 8 × 99407 ≈ $264 per patient annually

For a respiratory therapist seeing a panel of 500 Medicare patients with smoking-related disease, even a modest utilization rate could generate meaningful reimbursement while addressing a major driver of COPD, chronic bronchitis, emphysema, lung cancer, and cardiovascular disease.

The legislation applies only to respiratory therapists who:

• Hold the Registered Respiratory Therapist (RRT) credential
• Hold state licensure where required
• Possess a bachelor’s degree or higher
• Meet any additional CMS training requirements

Support legislation establishing Medicare payment for respiratory therapist professional services under physician-directed care. 

Improves Patient Access

• Expands access to preventive respiratory care, particularly in rural and underserved communities.
• Increases availability of smoking cessation counseling and respiratory disease management services.

Supports Medicare Prevention Goals

• Encourages evidence-based interventions that can reduce exacerbations, emergency department visits, and hospital admissions.

Builds on Existing Medicare Benefits

• Creates no new Medicare benefit. • Uses existing CPT codes already recognized and reimbursed by Medicare.

Maintains Appropriate Guardrails

• Requires a physician or practitioner-established plan of care.
• Prevents duplicate billing. • Maintains all state scope-of-practice protections.
• Includes program integrity safeguards and CMS oversight.

Budget-Conscious Approach

• Much narrower than previous broad Medicare Part B practitioner recognition proposals.
• Limited to existing preventive counseling services.
• Designed to minimize Medicare spending while improving patient access.

• Respiratory therapists already provide these services. 
• Medicare policy should reflect today’s healthcare delivery system. 
• Team-based care improves quality while reducing costs. 
• Earlier intervention reduces avoidable emergency department visits and hospital admissions. 

Access to Improved Respiratory Care Act (AIR Act) of 2026

• Section 1 — Short Title
  Designates the legislation as the Access to Improved Respiratory Care Act (AIR Act) of 2026.
• Section 2 — Findings and Purpose
  Recognizes the burden of chronic respiratory disease on Medicare beneficiaries and the healthcare system. Highlights the value of evidence-based respiratory care interventions, including tobacco cessation counseling, disease self-management education, and preventive respiratory services. Establishes the purpose of improving beneficiary access to qualified respiratory therapists and reducing avoidable healthcare utilization.
• Section 3 — Medicare Coverage of Respiratory Therapy Preventive ServicesCreates Medicare Part B authority for qualified respiratory therapists to furnish and bill for tobacco cessation counseling services using existing Medicare billing codes. Defines a qualified respiratory therapist as an individual who:
  • Holds a current respiratory therapy license where required by state law; • Holds the Registered Respiratory Therapist (RRT) credential or equivalent credential recognized by the Secretary; and • Possesses a bachelor’s degree or higher from an accredited institution.
  • Establishes coverage requirements, documentation standards, payment safeguards, and authorized sites of service.
• Section 4 — Physician Fee Schedule Payment
  Authorizes payment for covered services furnished by qualified respiratory therapists under the Medicare Physician Fee Schedule at the applicable non-physician practitioner payment rate.
• Section 5 — Implementation
  Directs the Secretary of Health and Human Services to issue regulations and operational guidance necessary to implement the legislation, including provider qualification standards, claims processing procedures, and program integrity safeguards.
• Section 6 — State Scope of Practice Protection
  Clarifies that nothing in the Act supersedes state licensure laws or modifies state scope-of-practice authority governing respiratory therapists.

During the COVID-19 public health emergency, virtual pulmonary rehabilitation demonstrated that clinically appropriate services can be delivered safely and effectively in patients’ homes. 

For many beneficiaries, particularly those in rural areas or with transportation barriers, virtual pulmonary rehabilitation offers an opportunity to participate in care that might otherwise be inaccessible. 

Permanent authority would: 

• Improve participation. 
• Increase completion rates. 
• Reduce travel barriers. 
• Expand rural access. 
• Support earlier intervention. 
• Improve patient convenience. 
• Complement in-person services when clinically appropriate. 

Support permanent Medicare authority for virtual pulmonary rehabilitation services