Sleep Study Medical Policy Update

Previously, we notified you of revisions to the Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policy, Diagnosis and Medical Management of Sleep Related Breathing Disorders (MED205.001). The updated policy is effective for services rendered on or after May 1, 2015.

Effective immediately, and to allow sufficient time to adjust to recent changes, we are implementing a period of voluntary compliance with BCBSTX Medical Policy MED205.001, Diagnosis and Medical Management of Sleep Related Breathing Disorders. While BCBSTX will not perform clinical review for approval or denial of benefit predetermination requests at this time (except for codes 95807 and 95808), it is requested that you will follow the guidelines in the policy.

BCBSTX will provide notice regarding when this voluntary compliance period will end. As we transition toward enforcement of the updated policy, we will keep you informed about when we will begin processing benefit predeterminations. We want to thank providers who submitted voluntary predetermination requests in the days since the policy took effect and we apologize for any inconvenience this change may have caused.

The BCBSTX 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 BCBSTX, such as some self-funded employer plans or governmental plans, may not utilize BCBSTX Medical Policies. Members should contact their local customer service representative for specific coverage information.