23 Miss. Code. R. 209-1.37 - Pulse Oximeter

A. Medicaid defines pulse oximeter as a photoelectric apparatus for determining the amount of oxygen in the blood. This is usually done by measuring the amount of light transmitted through a translucent part of the skin.

B. Medicaid covers pulse oximeters for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity, for rental up to purchase amount, or purchase if indicated when ordered by a physician and one (1) of the following criteria is met for a non-recording pulse oximeter:

1. The beneficiary has a documented serious respiratory diagnosis and requires short-term oximetry to rule out hypoxemia and/or determine the need for supplemental oxygen.

2. The beneficiary is dependent on a ventilator with supplemental oxygen.

3. The beneficiary has a tracheostomy and requires monitoring of O2 saturation as determined by the practitioner.

4. The beneficiary requires supplemental oxygen and has unstable saturations.

5. The beneficiary is on supplemental oxygen and weaning is in process.

C. Medicaid covers a recording pulse oximeter when all the following criteria is met:

1. The beneficiary's condition meets one (1) of the criteria for a non-recording oximeter, and

2. The recording oximeter is being ordered by the practitioner to monitor the beneficiary during a specific event such as a weaning attempt from oxygen or ventilator, feeding times for an infant, or other times for which the physician needs documentation of the patient's blood oxygen saturation.

Notes

23 Miss. Code. R. 209-1.37

42U.S.C. § 1395m; Miss. Code Ann. §§ 43-13-117(17), 43-13-121.

Amended 9/1/2018