Jan. 8, 2015

Diagnosis and Medical Management of Sleep Related Breathing Disorders

The purpose of this article is to provide you with a brief overview of recent updates to the Blue Cross and Blue Shield of Oklahoma (BCBSOK) Diagnosis and Medical Management of Sleep Related Breathing Disorders Medical Policy (MED205.001). The changes below will be effective for dates of service beginning April 15, 2015.

The policy coverage was revised to indicate that for adult patients with symptoms suggestive of Obstructive Sleep Apnea (OSA) and without significant co-morbidities, home sleep studies may be considered medically necessary.

Facility/laboratory polysomnography (PSG) is considered not medically necessary when the criteria for unattended home sleep studies are met. The use of an abbreviated daytime sleep study as a supplement to standard sleep studies, Positive Airway Pressure-Negative Airway Pressure (PAP-NAP), is considered experimental, investigational and/or unproven.

The BCBSOK Medical Policies are for informational purposes only and are not a replacement for the independent medical judgment of physicians. Physicians are to exercise their own clinical judgment based on each individual patient’s health care needs. Some benefit plans administered by BCBSOK, such as some self-funded employer plans or governmental plans, may not utilize BCBSOK Medical Policy. Members should contact their local customer services representative for specific coverage information.