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Home pulse oximetry is a safe, noninvasive method of measuring oxygen saturation levels. It is a standard of care when used in the management of patients with respiratory disorders who are on long-term oxygen therapy. The medical literature does not indicate that home pulse oximetry is effective for the screening or diagnosis of sleep disorders or necessary for the care of patients with stable respiratory disease. 

Intermittent or short-term pulse oximetry readings are routinely used in the home for patients on long-term oxygen therapy. It is part of the assessment used in determining the initial need for oxygen therapy. The need for ongoing oxygen should be assessed via pulse oximetry performed by the attending physician or an independent respiratory practitioner three months after initiation of home oxygen. Pulse oximetry is also performed for patients on long-term oxygen therapy when there is a change in their medical condition, to determine the appropriate oxygen settings. For patients on long-term oxygen therapy, an oximetric measurement is performed periodically to determine if the therapeutic goals are being met.

Oxygen therapy and pulse oximetry are often used in the home management of infants and children with chronic lung disease (e.g., bronchopulmonary dysplasia [BPD]). The American Thoracic Society (ATS), in the Statement on Care of the Child with Chronic Lung Disease of Infancy and Childhood, note that an oximeter in the home has the advantage of providing the caretaker with useful information. This can be particularly true during times of illness when the home oximetry reports may help determine whether the supplemental oxygen flow rate or concentration should be increased, or whether the child needs to be further evaluated in the office or emergency room. The ATS statement also notes that oxygen saturation measurements are utilized for this condition during the process of weaning from supplemental oxygen.

Ambulatory oximetry monitoring has been proposed as a tool for identifying candidates for long-term oxygen therapy for patients with chronic obstructive pulmonary disease (COPD). The standard method of determining oxygen requirements in these patients is based on a standard oximetric measurement. The ATS/European Respiratory Society (ERS) have noted that arterial blood gas assessment is the preferred method to determine oxygen need because it includes acid-base information. The ATS/ERS statement notes that arterial oxygen saturation as measured by pulse oximetry is adequate for trending. A prospective cohort study performed with 20 patients with COPD for the purpose of comparing the standard method with ambulatory oximetry monitoring found that there is a poor relationship between results of conventional methods and results from continuous ambulatory oximetry, but that additional studies are needed to determine if the prescription of oxygen based on continuous ambulatory oximetry can result in a higher percent of time in the desired oxygen saturation range.

Intermittent or short-term pulse oximetry in the home may be considered medically necessary for the periodic evaluation of oxygen saturation level for individuals on long-term medically necessary oxygen therapy.

Continuous or long-term pulse oximetry in the home may be considered medically necessary to monitor supplemental oxygen use for the following:

• individuals who require mechanical ventilation
• infants with chronic lung disease (e.g., bronchopulmonary dysplasia)
• premature infants on active therapy for apnea

Continuous home pulse oximetry is considered investigational when used as screening or diagnostic testing for sleep apnea.

Continuous home pulse oximetry is considered investigational for the monitoring of a stable respiratory condition.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

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Covered Codes

This is not intended to be a comprehensive list of codes. Some covered procedure codes have multiple descriptions.

The code(s) listed below are ONLY covered if the procedure is performed according to the "Policy" section of this document. 

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