Easy Breathe will be happy to call Anthem for you to check how much they will cover with us. Available at: Journal of the American Medical Association. Your email address will not be published. Westchester, IL: American Academy of Sleep Medicine; 2007. AHI greater than or equal to 15 events per hour of sleep in an asymptomatic individual or greater than five (5) events per hour of sleep in a symptomatic individual (e.g., sleepiness, fatigue and inattention). The terms of your CPAP machine, insurance coverage depends on your provider. If youve been diagnosed with sleep apnea, its likely that youll need a CPAP mask, as this is considered the best course of treatment for the condition. 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. endobj Continued use beyond the first three (3) months of therapy. Thankfully, the majority of Anthem Blue Cross Blue Shield PPO and HMO plans cover CPAP therapy supplies. More than 75 percent of the apneas or hypopneas must have an obstructive pattern. 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. Some providers reimburse you for the cost of purchasing the machine outright, while others require a rent-to-own plan under which you must use the machine for a set amount of time before it becomes your property. Updated Coding section with 01/01/2009 CPT changes; removed 0089T deleted 12/31/2008. An independent member of the Blue Shield Association 2.01.18 Diagnosis of Obstructive Sleep Apnea Syndrome Original Policy Date: April 3, 2009 Effective Date: October 1, 2022 Section: 2.0 Medicine Page: Page 1 of 26 . This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Agreement rates between actigraphy, diary, and questionnaire for children's sleep patterns. Directory Validation Instructions (No Surprises Act), Recredentialing & Credentialing Applications. Available at: Epstein LJ, Kristo D, Strollo PJ, et al. The term RDI was also corrected to be Respiratory Disturbance Index (not Distress index) and the measure known as RERAS was also added to this definition. American Academy of Sleep Medicine; Standards of Practice Committee. 2019; 10:551. This change affects all providers that manage sleep-related care for . Obstructive sleep apnea. 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. National Coverage Determination for Sleep Testing for Obstructive Sleep Apnea. MPTAC review. Hypertension x\Ys~W5p8krxv~qL 4@q_y)N&Bee\>U?0fxywC]|59wo_^UQ^C?^x"/0>_|}yiEQ$5U+/_'~M*yIaaT)GT=r4K%8K^VAfy?WC}l[6~;pklytDRRUAXH,{["GowQmU^VqU0V3,0m0O~d]y Im{W(x9AdWq &KaFgE/ +S/`5UeW'~S#s_jsE;kym+//}1M'x The following diagnostic tests are considered investigational and not medically necessary: The evidence in the medical literature does not support the use of single nap studies.
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