Oximetry Services

Pulse oximetry is covered when medically necessary for acute respiratory dysfunction (e.g., tachypnea, dyspnea, cyanosis, respiratory distress, confusion, hypoxia), for specified uses in patients with chronic lung/cardiopulmonary/neuromuscular respiratory disease (initial evaluation, acute change, exercise tolerance, or to establish oxygen therapy needs), for severe trauma or acute severe chest pain, for monitoring drug-related pulmonary toxicity, and for overnight monitoring when ABG sampling may miss important variations or to assess supplemental oxygen needs. Routine use and oximetry performed by DME suppliers for home oxygen qualification are not covered; services must meet this LCD and CMS medical necessity rules and be supported by medical records and available for audit. Frequency limits are not specified in the excerpt and are governed by the Utilization Guidelines; excess uses may be considered via individual consideration or redetermination processes.