CommercialAdministrativeLow impact
05.00.31e, Pulse Oximetry Devices in the Home Setting
Independence Blue Cross·PA · Pulmonology, Cardiology, Pediatrics +1 more·Medical Policy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued Policy 05.00.31e on 03/18/2026 with no substantive changes to pulse oximetry device coverage criteria. The policy maintains the existing medical necessity requirements for home pulse oximetry (patients on oxygen or being evaluated for oxygen therapy with specific clinical indications) and continues to exclude routine monitoring and other non-covered uses. No billing workflow changes are required.
Action Required
No immediate action required. This is a reissue with no changes to the policy terms, coverage criteria, or billing requirements. Billing team should update internal policy files to reflect the 03/18/2026 reissue date for compliance records, but existing billing practices for pulse oximetry devices (HCPCS codes A4606 and E0445) should continue unchanged. Ensure standard written orders and medical necessity documentation requirements remain in place as currently practiced.