Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers
Section 5160-10-23 - DMEPOS: pulse oximeters
Universal Citation: OH Admin Code 5160-10-23
Current through all regulations passed and filed through September 16, 2024
(A) Coverage.
(1)
Payment may be made only for a pulse oximeter that
meets the following criteria:
(a) It is
correctly calibrated, preset, and sealed such that its settings cannot be
adjusted by the average user; and
(b) It is capable either of converting data
(e.g., number of sampling hours, oxygen saturation level, aggregated results)
directly to electronic or printed form or of recording and storing data for
later conversion.
(2)
Payment may be made for a pulse oximeter on a rental/purchase basis. The
default certificate of medical necessity (CMN) form is the ODM 03401,
"Certificate of Medical Necessity: Pulse Oximeters" (rev. 7/2018). The CMN
includes an attestation by a prescriber that a need
exists either for diagnostic monitoring or for continuous monitoring:
(a) For diagnostic monitoring undertaken in
response to an acute clinical event or the exacerbation of an existing
condition, the prescriber includes the following information:
(i) An attestation that at least one of the
following two criteria has been met:
(a) The
individual was currently being weaned or was about to be weaned from an oxygen
supply; or
(b) The individual was
oxygen-dependent and was in a clinically unstable condition; and
(ii) Any previously recorded
oximeter data accompanied by an assessment of the resulting impact on the
management of the individual's care.
(b) For continuous monitoring twenty-four
hours per day, the prescriber attests to three statements:
(i) The individual exhibits clinical
instability (evidenced by chronically compromised respiration and frequently
varying oxygen requirements);
(ii)
The individual is at risk for critical fluctuations in oxygen saturation (e.g.,
hyperoxia, hypoxia), and
(iii) At
least one of the following conditions is present:
(a) Frequent bradycardia;
(b) Frequent oxygen desaturation;
(c) Chronic lung disease;
(d) Ventilator-dependency;
(e) Poor growth and development suggesting
inadequate oxygenation; or
(f)
Another specific risk factor that causes sudden, critical fluctuations in
oxygen saturation.
(3) The rental or purchase of a pulse
oximeter includes the following items and services:
(a) Service calls;
(b) Supplies and accessories (e.g., cable,
printer, printer tape, carrying case); and
(c) Probe wraps or tape.
(4) Separate payment may be made for
probes.
(B) Constraints and limitations.
(1) It is understood that because of the
nature of diagnostic monitoring, authorization for payment can generally be
granted only after the service has been provided.
(2) No single rental period can be longer
than three months.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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