This condition is associated with frequent awakening and often with daytime sleepiness. BCBS of Kansas, which covers approximately 560,000 members.. These RERA episodes represent EEG arousals associated with increased respiratory efforts but do not qualify as apneic or hypopneic episodes because of the absence of their defining air flow changes and/or levels of oxygen desaturation. AHRQ Technology Assessment Program. Often the machines themselves are covered to an extent, but you may be responsible for other components such as tubing. Call the National Information Center at 1-800-411-BLUE (2583)weekdays from 8 a.m. to 8 p.m. Eastern time. Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. A trial with CPAP has failed or is contraindicated; The device is prescribed by a treating physician; The device is custom-fitted by qualified dental personnel; There is absence of temporomandibular dysfunction or periodontal disease. PDF Medical Coverage Policy | Oral Appliances for Sleep Apnea - BCBSRI Clinical practice. 2007; 3(7):737-747. Obtain an order number Login or register with Carelon's ProviderPortal Phone 1 (877) 291-0509 J Clin Sleep Med. Available at: Kirk V, Baughn J, D'Andrea L, et al. Danny is a Certified Sleep Science Coach with an in-depth knowledge of sleep health. Another type of sleep disturbance is simply known as apnea or central apnea. This condition, caused by problems in the central nervous system, is unrelated to OSA and is not addressed in this document. Blue Cross Blue Shield of Massachusetts has delegated utilization management to Carelon Medical Benefits Management for Sleep Disorder Management. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. MPTAC review. Measurement of differences in the reflected wave signals enables a graphic representation of the variations in pharyngeal cross-sectional area at several anatomic levels. Here is what we need in order to verify your insurance coverage: After getting you a quote for your insurance benefits, Easy Breathe will help you contact your doctor's office for the following: These documents are needed in order to show medical necessity to your insurance company. Sleep Medicine - Regence Second, you must successfully complete a compliance period with the CPAP machine, to demonstrate that you are using the treatment regularly. MPTAC review. When you buy through our links, we may earn a commission. 2.01.18 Diagnosis of Obstructive Sleep Apnea Syndrome - Blue Shield of Billing for each individual component is considered unbundling of these supplies. Medical Management of Obstructive Sleep Apnea Syndrome Policy # 00328 Original Effective Date: 07/27/2012 Current Effective Date: 01/09/2023 2022 Blue Cross and Blue Shield of Louisiana . 4510 13th Ave. S. Coveredsleep apneaDiagnosis Codes for Procedure Code E0601, Non-Covered Diagnosis Codes for Procedure Code E0471. MPTAC review. Recommendations from other national entities may vary. JAMA. 4 0 obj Liners are products placed between the individuals skin and the PAP mask interface and are made of cloth, silicone or other materials. 2002; 347(7):498-504. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. 2005; 128(4):2166-2175. Involuntary sleepiness during activities that require some attention, such as meetings or presentations. Silber MH. American Academy of Sleep Medicine (AASM) Before most insurance providers will pay for your CPAP equipment, you must fulfill two requirements.
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