Medicare Advantage

Pulse Oximeters in the Home Setting
MA05.042a

Policy

Pulse oximeters (E0445) and replacement probes (A4606) in the home setting are not covered by the Company, because these items are not covered by Medicare. Therefore, these items are not eligible for reimbursement consideration.

Guidelines

This policy is consistent with Medicare’s coverage determination.

BENEFIT APPLICATION

Subject to the applicable Evidence of Coverage, pulse oximeters and replacement probes in the home setting and replacement probes are not eligible for payment under the medical benefits of the Company’s Medicare Advantage products because the service is considered not covered.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

There are numerous devices approved by the FDA for pulse oximetry.

Description

A pulse oximetry device indirectly measures the arterial oxygen saturation levels in the blood by using a noninvasive sensor probe on the ear or finger.

Coding

CPT Procedure Code Number(s)
N/A

ICD - 10 Procedure Code Number(s)
N/A

ICD - 10 Diagnosis Code Number(s)
N/A

HCPCS Level II Code Number(s)
A4606 Oxygen probe for use with oximeter device, replacement

E0445 Oximeter device for measuring blood oxygen levels noninvasively

Revenue Code Number(s)
N/A



Coding and Billing Requirements


Policy History

5/7/2018
8/1/2016
5/19/2021
MA05.042
Medical Policy Bulletin
Medicare Advantage
No