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Medical Policy Update: Diagnosis and Medical Management of Sleep Related Breathing Disorders

Posted January 15, 2015

Updates have recently been made to the BCBSIL Medical Policy for Diagnosis and Medical Management of Sleep Related Breathing Disorders (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

Additional information on these changes will be included in the February 2015 issue of the Blue Review.

*The content above does not apply to HMO members. 

The BCBSIL Medical Policies are for informational purposes only and are not a substitute for the independent medical judgment of physicians. Physicians are to exercise their own clinical judgment based on each individual patient’s health care needs. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan.  Members should refer to their certificate of coverage or summary plan description for more complete details regarding what services are covered including, benefits, limitations and exclusions. Some benefit plans administered by BCBSIL, such as some self-funded employer plans or governmental plans, may not utilize BCBSIL Medical Policy.