blue cross blue shield sleep apnea coverage

The reason for this is that CPAP devices are a class II medical device under FDA regulation, meaning you require a prescription in order to obtain one, and in order to get the prescription, you need to undergo a sleep study and have a board-certified sleep specialist physician interpret your results and prescribe CPAP treatment before you undergo CPAP therapy. Non-compliance, with the prescribed PAP therapy will render the PAP device as a non-covered service. 4 0 obj 2003; 26(6):754-760. PDF Blue Cross Blue Shield of Michigan Medical Policy Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. Damon Wiseley is a Registered Respiratory Therapist and Certified Pulmonary Function Technologist. Thankfully, the majority of Anthem Blue Cross Blue Shield PPO and HMO plans cover CPAP therapy supplies. Description and validation of the apnea risk evaluation system: a novel method to diagnose sleep apnea-hypopnea in the home. BOTH - Your signed Assignment of Benefits Agreement, which allows us to accept payment for the equipment from your insurance. is found to be more effective in the sleep lab to be . American Sleep Disorders Association and Sleep Research Society. Highmark Blue Cross Blue Shield has revised the coverage criteria for the Implantable Pulmonary Artery Pressure Measurement Device. More than 75% of the apneas or hypopneas must have an obstructive pattern. Trikalinos TA, Ip S, Raman G, et al. Episodes often result in reductions in blood oxygen saturation and are usually terminated by brief arousals from sleep. Medical policy list. Contact Carelon online via Carelon's ProviderPortalor call toll-free at 1 (877) 291-0509, 8 a.m. - 5 p.m. PST Monday through Friday to request an order number. The necessary doctors appointments and sleep studies come with their own costs, depending on your insurance plan and associated deductible. Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. 2007; 1:1-8. Centers for Medicare and Medicaid Services. Westchester, IL: American Academy of Sleep Medicine; 2007. Replacements of PAP devices for members with an existing diagnosis of OSA do not need a compliance chip if documentation of previous compliance, (i.e., compliance chip, telemonitoring, computer software), has been confirmed in the medical record. After reading and interpreting the results of your sleep study, your doctor may diagnose you with sleep apnea and work with you to develop a treatment plan. If you fail to meet these requirements, you have to begin the process again. A BiPAP device with back-up rate is considered not medically necessary with the primary diagnosis of OSA, in adults. Wide deviations in the conditions and data collection methods available cause significant variability in the outcomes of these studies and do not allow for proper sleep assessment. Insurance plans can significantly help defray the cost of a CPAP machine. A joint project sponsored by the American Academy of Sleep Medicine, the American Thoracic Society, and the American College of Chest Physicians. Save my name, email, and website in this browser for the next time I comment. Our site receives compensation from many of the offers listed on the site. When purchasing with an insurance provider, you are restricted to the suppliers that are covered by your insurance. It isnot intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. Because CPAP machines and their tubing are required daily, theyre subject to significant wear and tear, so you may be wondering how often insurance will cover CPAP supplies. Positive Airway Pressure (PAP) Supplies - Regence The use of specific product names is illustrative only. Adherence to therapy is defined as use of PAP greater than or equal to four (4) hours per night on 70% of nights during a consecutive 30-day period anytime during the first three (3) months of initial usage. This eliminates the possibility of needing to return your machine and restart the process of getting a sleep test and prescription from your doctor. 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). PDF Criteria Revised for Diagnosis and Treatment of Obstructive Sleep Apnea for Title was revised to remove MSLT and retitle: Selected Sleep Testing Services. Required fields are marked *. If you have a high deductible under your health insurance policy, you may inadvertently end up covering the full cost of your CPAP machine. Practice parameters for using polysomnography to evaluate insomnia: an update. Available at. Front Psychiatry. Easy Breathe will be happy to call Anthem for you to check how much they will cover with us. American Academy of Sleep Medicine; Standards of Practice Committee. 3 0 obj Danny is a Certified Sleep Science Coach with an in-depth knowledge of sleep health. Obstructive sleep apnea syndromes. Thanks for the feedback - we're glad you found our work instructive! Coverage continues if your sleep apnea improves with the CPAP treatment. Clinical practice. Chest. Netzer NC, Stoohs RA, Netzer CM, et al. Click the button below to request a free, no-obligation verification. Easy Breathe is one of the only online CPAP providers able to bill insurance. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. Be sure to check your insurance policy to determine your specific requirements. These tests include, but are not limited, to: nap studies, actigraphy, diagnostic audio-taping, topographic brain mapping, and acoustic pharyngometry. Available at: Journal of the American Medical Association. Updated the formatting of the Position Statement section. Sleep education. Note: CPAP has been shown to have greater effectiveness than oral appliances in general. Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. If your insurance company determines you are not using the machine frequently enough as per your policy, they may stop covering their portion of the machine rental. Hypertension Programs and resources to help you prevent and manage hypertension. Fletcher EC, Stich J, Yang KL. References were updated. State of South Carolina - Coverage Information The title was changed from: Diagnosis of Sleep Disorders to: Multiple Sleep Latency Testing and other Sleep Testing Services. 2004; 51(1):169-186. Agreement between actigraphic and polysomnographic measures of sleep in adults with and without chronic conditions: a systematic review and meta-analysis. Take the Sleep Quiz to help inform your sleep improvement journey. The following changes will be effective April 1, 2015, to the Blue Cross and Blue Shield of North Carolina corporate medical policy titled "Sleep Apnea: Diagnosis and Medical Management". In addition, studies have suggested that acoustic pharyngometry may be useful in identifying sites of airway narrowing. However, none of these portable tests currently provide diagnostic information that is superior to established Type III home portable monitors (HPM), which monitor and record a minimum of four parameters: respiratory movement/effort, airflow, ECG/heart rate, and oxygen saturation. Your daily habits and environment can significantly impact the quality of your sleep. Available at: Thurnheer R, Bloch KE, Laube I, et al. 3 results found for search term : sleep apnea Hypertension Programs and resources to help you prevent and manage hypertension. Sleep. PDF 969 Sleep Disorder Management - bluecrossma.org Measurement of differences in the reflected wave signals enables a graphic representation of the variations in pharyngeal cross-sectional area at several anatomic levels. 2020; 172(5):325-336. Available at: Kirk V, Baughn J, D'Andrea L, et al. <> Flemons WW, Littner MR, Rowley JA, et al. PDF Medical Policy - Sleep Disorders, Diagnosis and Medical Management Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Sleep. Med Clin North Am. This means your doctor still needs to conduct a sleep study to give you a diagnosis. Your insurance provider usually splits this cost with you, and the exact amount you pay depends on your policy. SDB is a common disorder that results in oxidative stress and inflammation of the upper airway. That said, coverage varies depending on your plan, insurance company, and authorization requirements. Policy and Coverage Criteria for Commercial Products: The AIM Clinical Appropriateness Guidelines include medical necessity criteria for Sleep Disorder Management: Validity of actigraphy compared to polysomnography for sleep assessment in children with autism spectrum disorder. x%xuY2dpVcE/@ah7F]UdjEfd?GD?gg_|?\g_vwV.{5Zn||6H3htwME#r7KG=.w.LrGK!gC$Z:UwcrYAR#Oc1e w|nl8.4qg2JAS]z7=H#{AYkt=C^zEg1fn). This process involves performing another sleep study to receive a new diagnosis of sleep apnea and another prescription for a CPAP machine. Hyde M, O'Driscoll DM, Binette S, et al. Some machines connect to an app on your phone and transmit usage information, while others use an SD card reader to collect the data. When services are Investigational and Not Medically Necessary: Unlisted otorhinolaryngological service or procedure [when specified as acoustic pharyngometry] (Note: CPT code 92520 Laryngeal function studies; aerodynamic testing and acoustic testing is not considered appropriate for this service), Actigraphy testing, recording, analysis, interpretation, and report; (minimum of 72 hours to 14 consecutive days of recording), Unlisted neurological or neuromuscular diagnostic procedure [when specified as nap study], Topographic brain mapping [for evaluation of a sleep disorder]. Payment may be made for one (1) appliance. Sleep Disorders. These tests vary in the number and nature of sleep parameters that are measured, in order to gain an understanding of the conditions under which sleep disturbances occur. It happens when the muscles in the throat relax and block the air passages to make sure . 1997; 127(8 Pt 1):581-587. PAP devices have directions from the manufacturing company included for cleaning. 3 months/90 days. Involuntary sleepiness during activities that require some attention, such as meetings or presentations. Seen as youll need a CPAP prescription from your doctor in order to make an insurance claim, you may be wondering how long your prescription is valid for. The indications for polysomnography and related procedures. Westbrook PR, Levendowski DJ, Cvetinovic M, et al. References were updated. Medicare participants are responsible for paying their deductible, plus 20% of the machine rental. Coding section was updated. Fargo, N.D., 58121. BiPAP machines, which provide a different level of air pressure for exhalation and inhalation, frequently run in the thousands of dollars. The Rationale, Definitions and References have been updated. Ann Intern Med. Smith MM, McCrae CC, Cheung JJ, et al. Available at: Morgenthaler T, Alessi C, Friedman L, et al. 2004; 130(1):58-66. Horizon Blue Cross Blue Shield of New Jersey partnered with the March of Dimes to offer an eLearning session on implicit bias called Awareness to Action: Dismantling Bias in Maternal and Infant Healthcare. Dont forget to budget the ongoing costs of tubes, filters, and other replacements. Most providers have replacement schedules for components such as tubes, masks, and filters that indicate how often replacements are covered. Inspire Medical wins more Blue Cross Blue Shield coverage Your email address will not be published. Premera Blue Cross, the largest health plan in the Pacific Northwest covering over 2.1 million members in Washington and Alaska. Acoustic Reflection Pharyngometry (Eccovision): This is a noninvasive device that uses acoustic signal processing technology to provide a graphical representation of airway patency. <> ** Medical Management of Obstructive Sleep Apnea Syndrome J Clin Sleep Med. %PDF-1.7 Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome.

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