blue cross blue shield sleep apnea coverage

J Clin Sleep Med. This type of sleep study has not been proven to meet the standards and capabilities of sleep studies conducted in a formal sleep laboratory. Please reference the Sleep Disorder Management order entry worksheets before submitting your request. Products or services advertised on this page may be offered by an entity that is affiliated with us. endobj This difference in efficacy is more pronounced for individuals with severe OSA, as oral appliances have been shown to be less efficacious in individuals with severe OSA than they are in individuals with mild-moderate OSA. Mysliwiec V, Martin JL, Ulmer CS, et al. Guilleminault C, Abad VC. The following codes for treatments and procedures applicable to this document are included below for informational purposes. If the individual is uncomfortable or intolerant of high pressures on CPAP; the individual may be tried on BiPAP. Obstructive sleep apnea. However, if the member is found to be using the PAP device as directed and is achieving the desired results, the DME supplier must contact the individual's physician near the end of the rental period and ask the doctor to prescribe the purchase of the device. This limits your coverage options, and you may not get the exact product you desire. Want to read more about all our experts in the field? AHRQ Technology Assessment Program. Patient-Centered Medical Home A patient-centered medical home is a new type of health care that makes you part of the team. Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. AIM will also manage treatment options for positive airway pressure (PAP) devices and related supplies/oral appliances for obstructive sleep apnea. Beginning November 1, 2020, we have a contracted network of dental providers with American Academy Dental Sleep Medicine (AADSM) certification to supply custom fitted sleep appliances (E0486) that are prescribed by a specialist in sleep disorders and authorized by our Utilization Management department according to the clinical guideline for coverage. Dise Is A Prerequisite To Inspire - Travel CPAPs: Insurance will not cover a second accessory CPAP for travel. If the criteria are not met, the accessories are considered not medically necessary. The term RDI was also corrected to be Respiratory Disturbance Index (not Distress index) and the measure known as RERAS was also added to this definition. These tests include, but are not limited, to: nap studies, actigraphy, diagnostic audio-taping, topographic brain mapping, and acoustic pharyngometry. Bear in mind that if you are required to rent for longer than a year, you may need to pay a second deductible. Trikalinos TA, Ip S, Raman G, et al. In order to buy a CPAP machine, you must have results from a sleep study and a CPAP prescription from your doctor or healthcare professional. All rights reserved. Medical policy list | Blue Shield of CA Provider Thanks for the feedback - we're glad you found our work instructive! The current body of evidence supporting the use of actigraphy for individuals with sleep disorders is insufficient to allow adequate conclusions regarding efficacy. This change affects all providers that manage sleep-related care for . Liners are not interfaces for use with a PAP mask. Over-the-counter (OTC) or prefabricated intra-oral appliances to treat OSA are not considered to be appropriate therapy for OSA in any clinical situation and, therefore, are non-covered. More than five (5) apneas, hypopneas, or RERAs per hour of sleep (i.e., an AHI or RDI greater than five (5) events per hour) in an individual with symptoms (e.g., sleepiness, fatigue and inattention), or signs of disturbed sleep (e.g., snoring, restless sleep, and respiratory pauses). The members contract benefits in effect on the date that services are rendered must be used. Acoustic Reflection Pharyngometry (Eccovision): This is a noninvasive device that uses acoustic signal processing technology to provide a graphical representation of airway patency. Most insurance plans partially cover the costs of CPAP machines and related equipment. Shift work sleep disorder (SWSD): A sleep disorder that is related to unusual or constantly changing work schedules and results in symptoms of insomnia or excessive sleepiness. When beginning CPAP treatment, the biggest upfront cost is the CPAP machine itself. The indications for polysomnography and related procedures. Sleep. Either a heated humidifier or a non-heated humidifier is eligible for use with a covered PAP device when prescribed by the treating physician to meet the needs of the individual. 1996; 11(2). Unattended home diagnosis and treatment of obstructive sleep apnea without polysomnography. BiPAP machines, which provide a different level of air pressure for exhalation and inhalation, frequently run in the thousands of dollars. This allows us to help CPAP patients with different insurance carriers in all 50 states, instead of being limited to one service area. Agreement rates between actigraphy, diary, and questionnaire for children's sleep patterns. Once you have the prescription, you can choose whether to buy your CPAP equipment outright or go through your insurance plan. However, if the member is found to be using the PAP device as directed and is achieving the desired results, the DME supplier must contact the individuals physician near the end of the rental period and ask the doctor to prescribe the purchase of the device. The phrase "investigational/not medically necessary" was clarified to read "investigational and not medically necessary." Obstructive Sleep apnea Devices for Out-Of-Center (OOC) testing: Technology Evaluation. Ann Intern Med. Chest. BCBSNC will provide coverage for Diagnosis and Medical Management of Sleep Apnea when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. When purchasing with an insurance provider, you are restricted to the suppliers that are covered by your insurance. Ann Intern Med. Typically, your deductible applies to essential CPAP equipment, not including optional accessories. American Academy of Sleep Medicine Position Paper for the Use of a Home Sleep Apnea Test for the Diagnosis of OSA in Children. Available at: Epstein LJ, Kristo D, Strollo PJ, et al. Standards of Practice Committee, American Academy of Sleep Medicine. Accessories used with a positive airway pressure (PAP) device may be considered medically necessary when the criteria for the device are met. Before making a final decision, please read the Plan's federal brochure (RI 71-005). First, you must have a prescription for CPAP therapy from your healthcare provider. Home/Portable sleep study (may also be known as NightWatch System, AutoSet Recorder, Morpheus System): A diagnostic test proposed for home use which may be self-administered or attended by a technician. Replacement of PAP Devices Watanabe T, Kumano-Go T, Suganuma N, et al. A BiPAP device with back-up rate is considered not medically necessary with the primary diagnosis of OSA, in adults. Individuals have confirmed diagnosis of OSA (confirmed via a positive facility-based PSG or with a positive home/portable sleep test); AHI greater than or equal to 15 events per hour of sleep in an asymptomatic individual. Your daily habits and environment can significantly impact the quality of your sleep. Topographic brain mapping has been briefly described in the evaluation and diagnosis of OSA. You also avoid the insurance requirements of treatment compliance. x%xuY2dpVcE/@ah7F]UdjEfd?GD?gg_|?\g_vwV.{5Zn||6H3htwME#r7KG=.w.LrGK!gC$Z:UwcrYAR#Oc1e w|nl8.4qg2JAS]z7=H#{AYkt=C^zEg1fn). compliance chip, telemonitoring, computer software), confirming that the member has been adhering to PAP therapy and is benefiting from its use. Typical CPAP device prices range from $250 to $1000 or more, not including the cost of necessary accessories such as filters and masks. Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. Seen as youll need a CPAP prescription from your doctor in order to make an insurance claim, you may be wondering how long your prescription is valid for. Go to www.providerportal.com Note: If you've already registered for the ProviderPortal for Blue Cross Blue Shield of Massachusetts or another insurer, you won't need to register again. Sleep disorders are some of the most common medical problems in the United States and have a significant impact on quality of life (QOL), productivity, and overall health. Medical Management of Obstructive Sleep Apnea Syndrome Policy # 00328 Original Effective Date: 07/27/2012 Current Effective Date: 01/09/2023 2022 Blue Cross and Blue Shield of Louisiana . Available at: Morgenthaler T, Alessi C, Friedman L, et al. Patient Page. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Title was revised to remove MSLT and retitle: Selected Sleep Testing Services. 2007; 3(7):737-747. 7it%:@zBdUyp}>3-2`Z62pVZHc0xLc8#* NXnr80(2 Assessing efficacy, outcomes and cost savings for patients with obstructive sleep apnea using two diagnostic and treatment strategies. It will be necessary for the provider to submit medical records and/or additional documentation to determine coverage in this situation. An AHI/RDI greater than 30 is consistent with severe OSA. Kamal I. Acoustic pharyngometry patterns of snoring and obstructive sleep apnea patients. This is a unique virtual learning experience for health care professionals caring for women and . 2008; 31(1):141-147. The relationship between esophageal pressure and apnea hypopnea index in obstructive sleep apnea-hypopnea syndrome. Your AHI is the average number of partial or complete breathing cessation events you experience per hour. 2017; 13(3):479504. Blue Cross Blue Shield of Massachusetts has delegated utilization management to AIM Specialty Health (AIM) for Sleep Disorder Management. SleepFoundation.org does not provide medical advice, diagnosis, or treatment options. Netzer NC, Stoohs RA, Netzer CM, et al. criteria for Sleep Disorder Management: Bi-Level Positive Airway Pressure (BPAP) Devices Management of Obstructive Sleep Apnea (OSA) Oral . Most other equipment ranges between $20 and $100.
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