Blue Cross Blue Shield has released a policy change on Diagnosis and Medical Management of Sleep Related Breathing Disorders, which will take effect in the states of Illinois, Montana, New Mexico, Oklahoma, and Texas on May 1, 2015.
The new policy clarifies and outlines the criteria for home sleep apnea testing (HSAT). Per this new Blue Cross Blue Shield policy, in-center polysomnography for sleep apnea is no longer considered medically necessary for most adult patients who lack significant signs of comorbidities. For these adults, the policy indicates that sleep testing should be performed using HSAT..
Under this new policy testing in a sleep center will be considered medically necessary only if one or more of the following criteria is met:
* A previous home study was found to be technically inadequate.
* A previous home study failed to establish the diagnosis of OSA in a patient with a high pretest probability of OSA.
* A home study is contraindicated due to co-morbid health conditions that may decrease the accuracy of the study, including but not limited to, moderate to severe pulmonary disease, neuromuscular disease, congestive heart failure or hypoventilation syndrome.
Read the policy by searching for medical policy number “MED205.001”.