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Clinical Policy: Outpatient Oxygen Use
This policy was pulled from the Marketing Command Center crawl, converted to markdown, cleaned of references and footer material, classified as a medical policy, and transformed into a question list for prior authorization review.
First five questions
- Is the member/enrollee ≥ 18 years of age?
- Is there physician-documented severe lung disease?Source criterion: Is there physician-documented severe lung disease or hypoxemia-related symptoms that might be expected to improve with oxygen therapy?
- Is there hypoxemia-related symptoms?Source criterion: Is there physician-documented severe lung disease or hypoxemia-related symptoms that might be expected to improve with oxygen therapy?
- Might the symptoms be expected to improve with oxygen therapy?Source criterion: Is there physician-documented severe lung disease or hypoxemia-related symptoms that might be expected to improve with oxygen therapy?
- Does the blood gas study meet Group I criteria by having an arterial PO₂ at or below 55 mm Hg?Source criterion: Does the blood gas study or pulse oximetry measurement meet Group I criteria by having an arterial PO₂ at or below 55 mm Hg, or an arterial oxygen saturation (or pulse oximetry) at or below 88 percent taken at rest (awake), breathing room air?
Linked services
Oxygen Concentrators (E1390, E1391, E1392) · Stationary Oxygen Systems (E0424, E0425, E0439, E0440) · Portable Oxygen Systems (E0430, E0431, E0433, E0434, E0435, K0738) · Oxygen Contents (E0441, E0442, E0443, E0444, E0447, S8120, S8121) · Oxygen and Water Vapor Enriching Systems (E1405, E1406) · Oximeter Device (E0445)
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