Does Medicare Cover a Pulse Oximeter?

A pulse oximeter is a small, non-invasive device that measures oxygen saturation levels in the blood and a person’s pulse rate. Typically, it clips onto a finger, toe, or earlobe, providing a rapid reading of how much oxygen the blood is carrying. This article explains Medicare’s approach to pulse oximeter coverage, including conditions for coverage, the process for obtaining a device, and related costs.

Medicare Coverage for Pulse Oximeters

Medicare generally classifies a pulse oximeter as a monitoring device, not durable medical equipment (DME), for routine home use. Therefore, Medicare typically does not cover the purchase of a pulse oximeter for general home use. These devices are widely available over-the-counter and are often considered personal health management tools.

However, specific, limited circumstances allow for continuous or overnight pulse oximetry coverage under Medicare Part B, often integral to oxygen therapy management. For coverage, a Medicare-enrolled doctor must deem the device medically necessary. This necessity usually arises from severe lung conditions or hypoxemia, where the patient’s oxygen levels are significantly low.

A formal oxygen saturation test using a pulse oximeter, administered by a doctor or qualified facility to assess oxygen therapy needs, may be covered. Covered situations include assessing unstable oxygen levels, determining appropriate oxygen flow rates, or monitoring patients on prolonged home mechanical ventilation. The device itself, when used for continuous monitoring in these medical contexts, may be covered if it dictates acute therapeutic intervention or validates the continued need for home oxygen therapy.

Steps to Obtain a Covered Pulse Oximeter

Obtaining a medically necessary pulse oximeter, within Medicare’s specific criteria, involves several steps. The process begins with a formal order or prescription from your Medicare-enrolled physician. This order must clearly state the device’s medical necessity and its intended use in your home.

After receiving a physician’s order, obtain the device from a Medicare-enrolled supplier. Confirm the supplier accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment. This limits your financial responsibility to the deductible and coinsurance. You can locate Medicare-approved suppliers through the Medicare.gov website’s directory or by asking your doctor for recommendations.

The supplier will process the claim directly with Medicare. They often require documentation from your doctor, such as test results or a Certificate of Medical Necessity (CMN), to support the coverage request. Ensuring all required documentation is complete and submitted by a Medicare-enrolled supplier who accepts assignment facilitates the coverage process and manages your potential costs.

Understanding Your Out-of-Pocket Costs

For a pulse oximeter meeting Medicare’s specific coverage criteria, your financial responsibility falls under Medicare Part B. You are responsible for meeting the annual Part B deductible before Medicare begins to pay. In 2025, this deductible is $257.

Once your deductible is met, Medicare Part B typically covers 80% of the Medicare-approved amount for the device. You are responsible for the remaining 20% coinsurance. Medicare may cover the rental or purchase of the equipment, which can influence the total cost structure.

If you have a Medicare Supplement (Medigap) plan, it can help cover some or all of your out-of-pocket costs, such as the Part B deductible and coinsurance. For individuals with a Medicare Advantage (Part C) plan, costs and rules for obtaining medically necessary equipment may differ from Original Medicare. While Medicare Advantage plans must provide at least the same level of coverage as Original Medicare, they may have their own network restrictions or prior authorization requirements. Check with your specific plan for details.