Feb. 5, 2015

In our January 2015 issue of Blue Review, we included an article titled, “Diagnosis and Medical Management of Sleep Related Breathing Disorders,” announcing medical policy revisions that will be effective for dates of service beginning April 15, 2015. The new effective date for this medical policy change is now extended to May 1, 2015.*

The article addressed recent revisions to the Blue Cross and Blue Shield of Oklahoma (BCBSOK) Medical Policy (MED205.001), Diagnosis and Medical Management of Sleep Related Breathing Disorders. These revisions align our medical policy with nationally recognized clinical criteria and current industry standards.

The revised policy establishes the medically appropriate utilization of home sleep apnea testing and polysomnography (PSG) in the diagnosis of Obstructive Sleep Apnea (OSA). For services rendered on or after this date, PSG and facility-based sleep study tests related to OSA and this medical policy will be subject to medical necessity review under the new medical policy criteria.

Providers are encouraged to obtain a medical necessity determination prior to services being rendered by submitting a Predetermination Request form. Access to this form can be obtained by visiting Education and Reference Center/Forms. Please follow the directions on the form for completion and submission.

To review the full medical policy, important details and general medical necessity criteria for OSA testing and treatment, visit the Standards and Requirements/Medical Policies section of our website at bcbsok.com/provider.

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.