Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Blue Cross Blue Shield of Massachusetts has delegated utilization management to AIM Specialty Health (AIM) for Sleep Disorder Management. Efforts are made to maintain reliable data on all information presented. 2020; 172(5):325-336. is found to be more effective in the sleep lab to be . The American Academy of Sleep Medicine (AASM) Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults, updated in 2009, stated: Actigraphy alone is not indicated for the routine diagnosis of obstructive sleep apnea (OSA) but may be a useful adjunct to portable monitors (PMs) when determining the rest-activity pattern during the testing period (Option) (Epstein, 2009). Typical CPAP device prices range from $250 to $1000 or more, not including the cost of necessary accessories such as filters and masks. Most insurance will not cover the following categories of products: - Cleaning Supplies: So Clean CPAP Sanitizer, Mask Wipes, etc. However, youre probably wondering about insurance. 2007; 1:1-8. Sleep disorder studies are used to determine or confirm a diagnosis related to sleep disturbances. Once you have the prescription, you can choose whether to buy your CPAP equipment outright or go through your insurance plan. The appropriate setting for standard CPAP treatment is determined during a titration sleep study. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. Again, this will depend on your individual insurance plan and provider, but in the case of Anthem they offer the following replacement schedule: Generally speaking, most insurance companies will authorize the replacement of CPAP masks, tubing, and filters every 90 days. The document header wording was updated from Current Effective Date to Publish Date. References were updated. J Sleep Res. More expensive accessories often come with warranties of 1 to 3 years. Medical Policy & Technology Assessment Committee (MPTAC) review. Kapur VK, Auckley DH, Chowdhuri S, et al. 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. Hypertension 2002; 347(7):498-504. of the following criteria are met: Throughout the PAP device rental period, the DME supplier must check that the member is compliant with use of the device. PAP devices have directions from the manufacturing company included for cleaning. Sleep Management - Blue Cross Blue Shield of Massachusetts Everyone's insurance plan is different. Obesity is defined as a BMI greater than the 90th percentile for the weight/height ratio. Covered sleep apnea Diagnosis Codes for procedure code E0601, Non-Covered Diagnosis Codes for procedure code E0471. Your doctor will first check for symptoms of obstructive sleep apnea, including: If your symptoms indicate you might have obstructive sleep apnea, the next step is to take a sleep study. 2005; 128(4):2166-2175. Non-compliance, with the prescribed PAP therapy will render the PAP device as a non-covered service. If the physician agrees that removal of the machine is warranted, the supplier must remove the machine and discontinue billing for the rental. If the device isn't being used as prescribed, the DME supplier should contact the individual's physician and discuss removal of the device. American Academy of Sleep Medicine (AASM) Chesson AL Jr, Ferber RA, Fry JM, et al. J Clin Sleep Med. OSA represents a very common diagnosis within the spectrum of sleep disorders and is the focus of this document. 3 months/90 days. eligible for coverage. Portable Monitoring Task Force of the American Academy of Sleep Medicine. Home sleep studies are covered to diagnose obstructive sleep apnea for members who fit the following description:

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