Information was added to the Rationale section regarding MWT, taken from the 2005 updated guideline on Practice Parameters for Clinical Use of MSLT and MWT from the American Academy of Sleep Medicine. The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. 2004; 291(16):2013-2016. Levenson JC, Troxel WM, Begley A, et al. Some rental plans may include the cost of replacement equipment, which is something to bear in mind when comparing the cost of buying outright versus going with insurance. Technology Evaluation Center (TEC) assessments. Liners must not be billed as replacement interface for a PAP mask or as a replacement cushion for use on nasal mask interface. This condition is also defined as a score greater than or equal to 10 on the Epworth Sleepiness Scale. This limits your coverage options, and you may not get the exact product you desire. Liners are not interfaces for use with a PAP mask. 2007; 146(3):157-166. These include: Insurance does not typically cover any products that are considered optional. Collop NA, Anderson WM, Boehlecke B, et al. Continued use beyond the first three (3) months of therapy Sleep Medicine - Regence Does Blue Cross Blue Shield Federal Cover Sleep Apnea Oral Appliance. Blue Cross Blue Shield of Massachusetts has delegated utilization management to Carelon Medical Benefits Management for Sleep Disorder Management. Diagnosis of Sleep Disorders and Treatment of Obstructive Sleep Apnea, Polysomnography and Other Sleep Studies in Adults, Polysomnography and Other Sleep Studies in Children. Annals Intern Med. Internal Medical Policy Committee 3-23-2022 Coding update-Added new procedure codes K1028 & K1029, effective April 01, 2022, Fargo (Headquarters) 4 0 obj Save my name, email, and website in this browser for the next time I comment. The Rationale, Definitions and References have been updated. 2004; 130(1):58-66. 2011; 7(5):531-548. Controversies in sleep medicine: terminology and definitions in sleep-disordered breathing. July 15, 2018. There are many different types of sleep-related disorders, including obstructive sleep apnea (OSA), upper airway resistance syndrome (UARS), insomnia, narcolepsy, nocturnal movement disorders, such as Restless Leg Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD), unexplained excessive daytime sleepiness, and arousal disorders (parasomnias). Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. Your insurance provider usually splits this cost with you, and the exact amount you pay depends on your policy. People with obstructive sleep apnea experience partial or complete closure of the upper airway during sleep, which can lead to snoring, gasping, or even choking. Risk factors for obstructive sleep apnea in adults. Sleep disorders are some of the most common medical problems in the United States and have a significant impact on quality of life (QOL), productivity, and overall health. Pediatrics. For general information about AIM Specialty Health, call 1-847-564-8500, Monday through Friday, from 9 a.m. to 6 p.m., Eastern Time (ET). State Medicaid programs typically follow the same guidelines as Medicare. Ann Intern Med. The effective date is February 26, 2018. Addition of acoustic pharyngometry to the testing considered investigational/not medically necessary. Acoustic Reflection Pharyngometry (Eccovision): This is a noninvasive device that uses acoustic signal processing technology to provide a graphical representation of airway patency. Apnea: A transient period where breathing ceases. Not all insurance plans work the same way. 2007; 137(5-6):97-102. If you have any questions about the guidelines, or wish to provide feedback, this can be done by contacting the Quality Improvement Department at 312-653-3465.

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