Consumer Grade Pulse Oximetry Devices For Use In The Home Setting (June 16, 2021)
MA05.042a Pulse Oximeters in the Home Setting
The purpose of this News Article is to provide advance notice during the COVID-19 outbreak related to the coverage of consumer grade pulse oximetry devices for use in the home setting.
The coverage of consumer grade pulse oximetry devices for use in the home setting is effective from June 1, 2020 and will be reevaluated for continuing applicability on October 31, 2021.
There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has now been detected both nationally and internationally. The virus has been named “SARS-CoV-2” and the disease it causes has been named “Coronavirus Disease 2019” (COVID-19). The SARS-CoV-2 virus has demonstrated the capability to rapidly spread, leading to significant impacts on healthcare systems and causing societal disruption. The potential public health threat posed by COVID-19 is high globally. To effectively respond to the COVID-19 outbreak, rapid detection of cases and contacts, appropriate clinical management and infection control, and implementation of community mitigation efforts are critical.
The Company will provide coverage for consumer grade pulse oximetry devices for use in the home setting for patients under investigation (PUI) or with a confirmed diagnosis of COVID-19, under the care of a professional provider when all the following criteria are met:
The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports.
BILLING REQUIREMENTS FOR CONSUMER GRADE PULSE OXIMETRY DEVICES
Eligible providers supplying consumer grade pulse oximetry devices for use in the home setting must report Healthcare Common Procedure Coding System (HCPCS) code E0445 along with the COVID-19 diagnosis code or diagnosis codes consistent with the symptoms of COVID-19.
Consumer grade pulse oximetry devices may be considered eligible for reimbursement, when supplied by an in-network designated DME supplier, professional provider, or home health agency. Referral requirements for HMO and POS members have been waived for consumer grade pulse oximetry devices when supplied by an eligible provider.
Inclusion of a code in this News Article does not imply reimbursement. Eligibility, benefits, limitations, exclusions, provider contracts, and Company policies apply.
RELATED POLICY BULLETINS
Medical grade pulse oximetry devices in the home setting are addressed in the current versions of the following policy bulletin:
- The individual presented with symptoms consistent with COVID-19 (e.g., congestion or runny nose, cough, shortness of breath or difficulty breathing, fatigue, fever or chills, muscle or body aches, headache, sore throat, nausea or vomiting, diarrhea, new loss of taste or smell).
- The consumer grade pulse oximeter is ordered by a professional provider.
- The individual or a trained caregiver has the physical and cognitive capacity to monitor their symptoms and to understand the importance of seeking medical guidance should symptoms progress.
Dosing and Administration
Black Box Warnings and/or Contraindications
- MA05.042a Pulse Oximeters in the Home Setting
CODE(S) AND NARRATIVE(S)
|COVID-19 Diagnosis |
One or more of the following COVID-19 symptoms. (Note: this list is not all-inclusive)
R06.00 Dyspnea, unspecified
R06.02 Shortness of breath
R07.0 Pain in throat
R09.81 Nasal congestion
R11.10 Vomiting, unspecified
R11.11 Vomiting without nausea
R19.7 Diarrhea, unspecified
R43.8 Other disturbances of smell and taste
R50.9 Fever, unspecified
R51.9 Headache, unspecified
R52 Pain, unspecified
R53.83 Other fatigue
R68.83 Chills (without fever)
HCPCS Level II
|The Following Code Is Used To Represent Consumer Grade Pulse Oximeter Device when billed with NU Modifier|
E0445 Oximeter device for measuring blood oxygen levels noninvasively
NU New durable medical equipment purchase