COVID-19 (Coronavirus): Coverage for respiratory equipment and related supplies

December 2, 2020

This article was revised on December 2, 2020, to update the policies' effective dates.

AmeriHealth is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all AmeriHealth members and providers to visit our dedicated AmeriHealth New Jersey and AmeriHealth Pennsylvania COVID-19 webpages regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Respiratory equipment and related supplies

From March 6, 2020, through March 31, 20211, AmeriHealth will provide coverage for respiratory equipment (e.g., ventilator, respiratory assist device) and supplies to support ongoing acute care respiratory services in the home setting. Quantity limits for medically necessary respiratory supplies will be waived during the COVID-19 public health emergency.

AmeriHealth is temporarily suspending prior authorization requirements for continuous positive airway pressure (CPAP) devices, bi-level (Bi-PAP) devices, and all supplies.

1Subject to re-evaluation for the duration of the public health emergency.

Coding

A complete list of codes for ventilator, respiratory assist device/CPAP device, home oxygen, and supplies can be found within the policies outlined in the News Article, Respiratory Equipment and Related Supplies (updated July 17, 2020), in the News & Announcements section of our Medical and Claim Payment Policy Portal.

Consumer grade pulse oximetry devices

From June 1, 2020, through March 31, 20211, AmeriHealth will provide coverage for consumer grade pulse oximetry devices for use in the home setting for patients under investigation or with a confirmed diagnosis of COVID-19. The patient must be under the care of a professional provider and meet these criteria:

  • The individual presented with symptoms consistent with COVID-19 (e.g., congestion or runny nose, cough, shortness of breath or difficulty breathing, fatigue, fever or chills, muscle or body aches, headache, sore throat, nausea or vomiting, diarrhea, new loss of taste or smell).

  • The consumer grade pulse oximeter is ordered by a participating professional provider.

  • The individual or a trained caregiver has the physical and cognitive capacity to monitor their symptoms and to understand the importance of seeking medical guidance should symptoms progress.

The patient's medical record must reflect the medical necessity for the care provided. These medical records may include but are not limited to records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

1Subject to re-evaluation for the duration of the public health emergency.

Waivers and exclusions

AmeriHealth has waived member cost-share2 (i.e., copayment, deductible, and coinsurance) and referral requirements (HMO and POS members) for consumer grade pulse oximetry devices subject to the requirements set forth herein. Cost-share and referrals are waived when the device is supplied by an eligible participating provider. A list of our dedicated participating durable medical equipment (DME) suppliers is provided below.

2Self-funded customers can choose to opt out of the cost-share waiver.

Dedicated pulse oximetry providers

AmeriHealth is working with several dedicated participating pulse oximetry providers to supply equipment to our members.

If a patient satisfies the clinical coverage criteria in a facility (i.e., ED visit), the discharging physician should provide a prescription to the member with the contact information for one of our dedicated DME suppliers. The member – or medical personnel on behalf of the member – should call the DME supplier directly to arrange home delivery of the pulse oximeter.

The AmeriHealth dedicated participating DME suppliers are:

  • Apria (Phone: 1-855-709-9966; Fax: 1-888-492-0010)
  • Better Living Now (1-877-290-5186)
  • Complete Medical Supplies (1-866-748-5151)
  • Montgomery Medical (610-630-6357)
  • Specialty Medical Products (610-644-1370)

Coding

Providers who supply consumer grade pulse oximetry devices for use in the home setting must report Healthcare Common Procedure Coding System (HCPCS) code E0445 along with Modifier NU (new durable medical equipment purchase) and the COVID-19 diagnosis code or diagnosis codes consistent with the symptoms of COVID-19.

Consumer grade pulse oximetry devices may be considered eligible for reimbursement, when supplied by a dedicated participating DME supplier, professional provider, or home health agency.

A complete list of codes for consumer grade pulse oximetry devices can be found within the policies outlined in the News Article, Consumer Grade Pulse Oximetry Devices For Use In The Home Setting, in the News & Announcements section of our Medical and Claim Payment Policy Portal.

Learn more

For more information about the AmeriHealth position on COVID-19, please review the following resources: