Medical policy update reminder: Diagnosis and medical management of sleep related breathing disorders

An important change to the Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policy for Diagnosis and Medical Management of Sleep Related Breathing Disorders (MED205.001) will take effect for dates of service on or after May 1, 2015. This policy has been revised to establish new criteria and guidance for testing in the diagnosis of Obstructive Sleep Apnea (OSA).

A detailed article regarding this revised medical policy was published in our March 2015 Blue Review. Here is a quick summary of key points, for your convenience:

• According to the revised medical policy, the facility/lab setting will be generally considered medically unnecessary unless the member fulfills a specific set of criteria.
• For dates of service on or after May 1, 2015, providers are encouraged to submit a predetermination request form, along with supporting documentation.
• Prior to May 1, 2015, you may wish to review the revised medical policy in the Medical Policy/Pending Policies section of the BCBSTX provider website.