SPECIAL BULLETIN COVID-19 #52: Coverage for Weight Scales and Portable Pulse Oximeters - Temporary Flexibilities

Monday, April 20, 2020

Effective retroactive to March 10, 2020, Medicaid and NC Health Choice plans are temporarily covering weight scales and adding a purchase option for portable pulse oximeters. These temporary flexibilities will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded.

Suppliers must maintain the usual documentation of medical necessity and records per applicable policy guidance. All claims are subject to audit.

Coverage for Weight Scales, HCPCS code E1639

Medicaid and NC Health Choice coverage is added for HCPCS code E1639 – scale, each. If determined to be medically necessary by the prescriber, a floor scale, regular capacity or extra capacity, may be provided without prior authorization to beneficiaries required to independently monitor their body weight from home. Coverage for this item is available through the following clinical programs:

  • Durable Medical Equipment and Supplies (clinical coverage policy 5A-3)
  • Home Health Services (clinical coverage policy 3A)
  • Home Infusion Therapy (clinical coverage policy 3H-1)
  • Private Duty Nursing (clinical coverage policies 3G-1 and 3G-2)

Addition of Purchase Option for Portable Pulse Oximeters, HCPCS code E0445

Medicaid and NC Health Choice coverage is added for a purchase option of HCPCS code E0445 – oximeter device for measuring blood oxygen levels noninvasively, through the Durable Medical Equipment (DME) program. This new purchase option is in addition to the current rental option for hospital grade, table-top pulse oximeters described in DME policy 5A-2, Respiratory Equipment and Supplies. 

If determined to be medically necessary by the prescriber, a portable pulse oximeter may be provided without prior authorization to beneficiaries required to independently monitor their blood oxygen levels noninvasively from home. The prior authorization criteria for oximeters set forth in DME policy 5A-2, subsection 5.3.2 need not apply.

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NCTracks Contact Center: 800-688-6696