blue cross blue shield sleep apnea coverage

Quantities of supplies greater than those identified as the usual maximum amounts will be denied as not medically necessary. Front Psychiatry. Medical Policy & Technology Assessment Committee (MPTAC) review. Hypertension The document header wording was updated from Current Effective Date to Publish Date. References were updated. Often the machines themselves are covered to an extent, but you may be responsible for other components such as tubing. Another benefit to paying a medical equipment supplier directly is the wider choice of products available to you. Close follow-up for PAP device usage and problems in individuals with sleep apnea by appropriately trained health care providers is indicated to establish effective utilization patterns and remediate problems if needed. Interpretation Obstructive Sleep Apnea (OSA) syndrome consists of a collection of symptoms including daytime sleepiness, fatigue, snoring, and restless sleep with a disrupted sleep pattern. Validity of actigraphy compared to polysomnography for sleep assessment in children with autism spectrum disorder. Payment may be made for one (1) appliance. No change to criteria except for the addition of or to the medically necessary indications for MSLT in place of the and for clarification. Danny is a Certified Sleep Science Coach with an in-depth knowledge of sleep health. Kapur VK, Auckley DH, Chowdhuri S, et al. Behavioral Health Companion Benefit Alternatives (CBA) manages behavioral health benefits for the State Health Plan. The updated 2009 AASM document does not address MWT, nap studies, audio recording, SNAP testing, acoustic pharyngometry or topographic brain mapping (Epstein, 2009). Silber MH. Coverage continues if your sleep apnea improves with the CPAP treatment. A replacement device is not covered if due to misuse or abuse and is considered a non-covered service. Easy Breathe works with your Blue Cross PPO plan as an out-of-network provider. Sleep. If there are continued obstructive respiratory events at 15 cm H2O of CPAP during the titration study, the individual may be switched to BiPAP; For whom BiPAP is found to be more effective in the sleep lab. According to SoClean CEO Bob Wilkins, there are roughly 8 million CPAP users in the United States, and this is growing yearly. The following codes for treatments and procedures applicable to this document are included below for informational purposes. 2017; 13(10):1199-1203. 1 0 obj Accessories used with a positive airway pressure (PAP) device may be considered medically necessary when the criteria for the device are met. Available at: Thurnheer R, Bloch KE, Laube I, et al. Not sure what your Blue Cross insurance covers? The allowance of a replacement mask interface every month is considered an exception and documentation should support the medical necessity. In order to buy a CPAP machine, you must have results from a sleep study and a CPAP prescription from your doctor or healthcare professional. Liners are not interfaces for use with a PAP mask. Darien, IL: AASM; 2020. We work with Anthem Blue Cross and Blue Shield PPO plans nationwide. minimally invasive solutions for patients with obstructive sleep apnea, announced today that three new Blue Cross Blue Shield Association ("BCBSA") healthcare plans have issued positive coverage policies of Inspire therapy. The Ultimate Overview to Sleep Apnea with Effects, Therapy, Monitoring, Causes & Threat Factors Does Blue Cross Blue Shield Federal Cover Sleep Apnea Oral Appliance. 1997; 20(12):1208. First, your doctor must diagnose you with obstructive sleep apnea following an approved laboratory sleep study or an at-home sleep study, and give you a prescription for a CPAP machine. 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. Your email address will not be published. 2008; 31(1):141-147. stream This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Note:See the table below for the usual maximum amount of accessories considered to be medically necessary. Arch Fam Med. Agreement rates between actigraphy, diary, and questionnaire for children's sleep patterns. stream Portable sleep studies for the diagnosis of obstructive sleep apnea syndrome. Does Blue Cross Blue Shield Federal Cover Sleep Apnea Oral Appliance. Paying for your equipment directly gives you the opportunity to compare products and choose the CPAP equipment you find most suitable. Covered sleep apnea Diagnosis Codes for procedure code E0601, Non-Covered Diagnosis Codes for procedure code E0471. BCBSNC will provide coverage for Diagnosis and Medical Management of Sleep Apnea when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. These are not considered interfaces as defined in this policy. The members contract benefits in effect on the date that services are rendered must be used. In addition, studies have suggested that acoustic pharyngometry may be useful in identifying sites of airway narrowing. Non-compliance, with the prescribed PAP therapy will render the PAP device as a non-covered service. Schechter MS. American Academy of Pediatrics technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Patient-Centered Medical Home A patient-centered medical home is a new type of health care that makes you part of the team. BCBSNC will provide coverage for surgery for obstructive sleep apnea and upper airway resistance syndrome when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. Kryger MH. Note: CPAP has been shown to have greater effectiveness than oral appliances in general. J Clin Sleep Med. Available at: Kirk V, Baughn J, D'Andrea L, et al. However, if the member is found to be using the PAP device as directed and is achieving the desired results, the DME supplier must contact the individuals physician near the end of the rental period and ask the doctor to prescribe the purchase of the device. Agency for Healthcare Research and Quality (AHRQ), Rockville, MD; August 8, 2007. Upper airway: The area of the upper respiratory system including the nose, mouth and throat. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. Keep in mind that whether or not you use insurance, medical equipment sellers require a CPAP prescription in order for you to purchase the machine and equipment. References and Coding sections were also updated. 1 0 obj Sleep-disordered breathing (SDB): A term for abnormalities of respiration during sleep. Billing for each individual component is considered unbundling of these supplies. Coding section was updated. An American Sleep Disorders Association Report. Hypertension Programs and resources to help you prevent and manage hypertension. Conley S, Knies A, Batten J, et al. Save my name, email, and website in this browser for the next time I comment. MPTAC review. Standards of Practice Committee of the American Sleep Disorders Association. The cost you pay depends on your insurance coverage.In addition to the CPAP machine itself, you also need to pay for additional equipment such as filters, which run between $5 and $30, and masks, which can cost up to $100. Home diagnosis of sleep apnea: a systematic review of the literature. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. Many portable tests have been proposed as alternatives to laboratory-based PSG for the diagnosis and follow-up of sleep disorders. We regularly assess how the content in this article aligns with current scientific literature and expert recommendations in order to provide the most up-to-date research. Easy Breathe works with your Blue Cross PPO plan as an out-of-network provider. American Academy of Sleep Medicine. 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. Polysomnography (PSG) also typically includes electrocardiography and monitoring of References and Coding were updated. The Rationale, Definitions and Reference sections have also been updated. No. Revision based on Harmonization: Pre-merger Anthem and Pre-merger WellPoint. However, the evidence is limited to small case series studies that do not allow adequate evaluation of this technology. J Clin Sleep Med. SleepFoundation.org does not provide medical advice, diagnosis, or treatment options. - Your signed Assignment of Benefits Agreement, which allows us to accept payment for the equipment from your insurance. MPTAC review. Home diagnosis of obstructive sleep apnea-hypopnea syndrome. The relationship between esophageal pressure and apnea hypopnea index in obstructive sleep apnea-hypopnea syndrome. MPTAC review. Continuous positive airway pressure (CPAP): This is a noninvasive treatment for OSA that involves delivery of pressurized air during sleep through a device that snugly covers the nose. Costs for purchasing a machine outright can range anywhere from $250 to $1,000 or more, depending on where you live and the type of machine you need. Federal and State law, as well as contract language, including definitions and specific contract provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. endobj 2012; 130(3):576-584. Addition of medically necessary criteria for home/portable sleep studies to confirm diagnosis of obstructive sleep apnea. 2007; 16(2):213-216. This process involves performing another sleep study to receive a new diagnosis of sleep apnea and another prescription for a CPAP machine. 1. Flemons WW, Littner MR, Rowley JA, et al. References were updated. 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. Townsend D, Sharma A, Brauer E, et al. Device expenses incurred during the first three (3) months of rental will be applied to the purchase price. The major danger variables for sleep apnea are weight problems, age , huge neck dimension, aging, as well as smoking. The use of specific product names is illustrative only. Along with key review factors, this compensation may impact how and where products appear across the site (including, for example, the order in which they appear). Sleep Diag Ther. If you're ready for more, sign up to receive our email newsletter! 3 results found for search term : sleep apnea Hypertension Programs and resources to help you prevent and manage hypertension. BiPAP machines, which provide a different level of air pressure for exhalation and inhalation, frequently run in the thousands of dollars. He has tested hundreds of mattresses and sleep products. Nap study: This term refers to a shorter daytime version of a PSG sleep study. Iber C, Ancoli-Israel S, Chesson AL, Quan SF. 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 . Bi-level Positive Airway Pressure(BiPAP) without back-up rate. Many insurance providers require you to meet your annual deductible before covering your CPAP equipment. Medical and surgical treatments for obstructive sleep apnea syndrome are in benefit. 7it%:@zBdUyp}>3-2`Z62pVZHc0xLc8#* NXnr80(2 Your prescription may display an expiration date, in which case it will be valid until this date. Technology Evaluation Center (TEC) assessments. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine Clinical Practice Guideline. This document addresses selected services for the diagnosis of sleep disorders including: Investigational and Not Medically Necessary: Nap studies are considered investigational and not medically necessary either for screening purposes or as an alternative to polysomnography for the diagnosis of obstructive sleep apnea or narcolepsy. Non-compliance, with the prescribed PAP therapy will render the PAP device as a non-covered service. Chest. Your daily habits and environment can significantly impact the quality of your sleep. 4 0 obj Central Sleep Apnea (CSA) is a serious breathing disorder that disrupts the normal breathing pattern during sleep and negatively affects quality of life and overall cardiovascular health. Revisions also made to Coding section for clarification of MWT coding. We work with Anthem Blue Cross and Blue Shield PPO plans nationwide. This revised Medical Policy will apply to both professional provider and facility claims. Costs for these products can vary depending on the quality. Neurol Clin. An APAP device or CPAP device may be considered medically necessary for the treatment of obstructive sleep apnea (OSA) in adults and covered as durable medical equipment when the following criteria are met: APAP or CPAP devices not meeting the criteria as indicated in this policy are considered not medically necessary. Benefits Application This medical policy relates only to the services or supplies described herein. Click the button below to submit your insurance information to us and get started! Ann Intern Med. A liner used in conjunction with a PAP mask is considered a comfort and convenience item and is considered a non-covered item or service. With Original Medicare coverage, you pay 20% of the machine rental plus the cost of supplies such as the CPAP mask and tubing. Compliance monitoring equipment for CPAPs, APAPs, or BiPAPs (e.g., smart card, compliance chip, tele monitoring, and computer software) is considered an integral component of the function of the device and is not eligible for separate reimbursement. Children frequently exhibit behavioral problems or hyperactivity rather thandaytime sleepiness. Yavuz-Kodat E, Reynaud E, Geoffray MM, et al. Well cover some of the most common insurance policies surrounding CPAP equipment. %PDF-1.7 The phrase "investigational/not medically necessary" was clarified to read "investigational and not medically necessary." 2013; 36(11):1747-1755. Additionally, nap sleep is not physiologically the same as nighttime sleep and does not adequately reflect the range of sleep phases required for proper diagnosis, therefore, results are not accurate when compared to the current standard of a full polysomnography (PSG). Trikalinos TA, Ip S, Raman G, et al. Well answer some of the most commonly asked questions about CPAP machines, equipment, and insurance coverage. When you buy through our links, we may earn a commission. Sleep. <>/Metadata 259 0 R/ViewerPreferences 260 0 R>> Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. Measurements usually involve the detection of wrist movements. 2002; 347(7):498-504. Before most insurance providers will pay for your CPAP equipment, you must fulfill two requirements. A quantitative approach to distinguishing older adults with insomnia from good sleeper controls. There is additionally a vital hereditary component to the disease. Otolaryngol Head Neck Surg. 2017; 13(3):479504. 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". <>/Font<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Insurance providers typically take your apnea-hypopnea index (AHI) into consideration when determining your eligibility for CPAP therapy coverage. SDB is associated with sleep disorders, such as OSA and also multiple age-related health disorders. endobj Controversies in sleep medicine: terminology and definitions in sleep-disordered breathing. 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. However, youre probably wondering about insurance. AHRQ Technology Assessment Program. Obesity is defined as a BMI greater than the 90th percentile for the weight/height ratio. Efforts are made to maintain reliable data on all information presented. If the criteria are not met, the accessories are considered not medically necessary. A position statement regarding MWT was added. Guidelines are designed to support the decision-making processes in patient care. When beginning CPAP treatment, the biggest upfront cost is the CPAP machine itself. <> American Academy of Pediatrics (AAP). These coverage types are separate from one another. Yes! % This allows us to help CPAP patients with different insurance carriers in all 50 states, instead of being limited to one service area. 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. Your provider will bill your insurance company monthly, and, at the end of this rental period, you will own the device. Hyde M, O'Driscoll DM, Binette S, et al. This means your doctor still needs to conduct a sleep study to give you a diagnosis. Sleep. BCBS of Kansas City, March 1, 2019 . American Academy of Sleep Medicine (AASM). 2011; 7(5):531-548. However, if your plan has a high deductible, you might be tempted to purchase your CPAP equipment on your own and bypass your insurance. MPTAC review. However, how often they replace these, and how much of the cost your insurance covers, of course depends on your policy and the company youre with. 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 Chest. These plans include: Highmark, Inc.; Blue Cross Blue Shield ("BCBS") of Alabama; and BCBS of South Carolina, which . Once the 13 months have passed, you own the machine. Masks often cost $100 or more, and other equipment ranges between $20 and $100. 2003; 87(4):803-833. 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. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. More than fifteen (15) apneas, hypopneas, or respiratory effort related arousals (RERAs) per hour of sleep (i.e., an apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) greater than fifteen (15) events/hr.) Clinical practice. 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. Be sure to check your insurance policy to determine your specific requirements. 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. More than five (5) apneas, hypopneas, or RERAs per hour of sleep (i.e., an AHI or RDI greater than five (5) events per hour) in an individual with symptoms (e.g., sleepiness, fatigue and inattention), or signs of disturbed sleep (e.g., snoring, restless sleep, and respiratory pauses). Sleep Apnea. %PDF-1.7 It can be mild, moderate, or severe, based on the number of times each hour that breathing stops (apnea) or slows (hypopnea). If you fail to meet these requirements, you have to begin the process again. 2023 Blue Cross Blue Shield of North Dakota, Please wait while your form is being submitted, Devices Used for the Treatment of Sleep Apnea in Adults, A positive airway pressure device (CPAP, BPAP-ST,) may be considered medically necessary for the first three (3) months of therapy for those individuals with central sleep apnea (CSA) that have had an attended polysomnogram, performed on stationary equipment. There are a number of optional accessories you can purchase for your CPAP machine. Sleep disorder: A disruptive pattern of sleep that may include difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep. This condition is associated with frequent awakening and often with daytime sleepiness. Typically, you need a referral for a sleep study in order to receive coverage. Episodes often result in reductions in blood oxygen saturation and are usually terminated by brief arousals from sleep. JAMA. Netzer NC, Stoohs RA, Netzer CM, et al. JAMA. Dont forget to budget the ongoing costs of tubes, filters, and other replacements. Your email address will not be published. But don't worry - our team will handle the legwork in getting them to your insurance company. Some studies have suggested a correlation between pharyngeal cross-sectional areas measured using acoustic pharyngometry and the presence of OSA. A BiPAP device with back-up rate is considered not medically necessary with the primary diagnosis of OSA, in adults. Please reference the Sleep Disorder Management order entry worksheets before submitting your request. Epworth sleepiness scale (ESS): A standardized measure of the degree of sleepiness. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Portable Monitoring Task Force of the American Academy of Sleep Medicine. Chesson AL Jr, Ferber RA, Fry JM, et al. 2000; 3(4):169-172. Blue Cross Blue Shield of Massachusetts has delegated utilization management to Carelon Medical Benefits Management for Sleep Disorder Management. Anthems insurance plans will cover CPAP supplies that are deemed a medical necessity for OSA (obstructive sleep apnea), such as: However, the cost of other accessories for your CPAP machine, including things like cleaning devices or wipes, batteries, or duplicate machines such as travel versions, will not be covered. Medical policy list. If your CPAP prescription mentions a Lifetime Need or says 99 months, this means that the prescription is valid for as long as you require the therapy. Version 2.6. The exclusion of obstructive sleep apnea (OSA) as the predominant cause of sleep-associated hypoventilation; For BPAP-ST, the ruling out of CPAP as effective therapy if OSA is a component of the sleep-associated hypoventilation; Significant improvement of the sleep-associated hypoventilation with the use of either PAP device on the settings that will be prescribed for initial use at home, while breathing the individual's prescribed FIO2. Werner H, Molinari L, Guyer C, Jenni OG. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Morgenthaler TI, Aurora RN, Brown T, et al. 2004; 51(1):169-186. A provider's office can often get an immediate approval when they submit a request online. Ann Intern Med. 2002; 165(11):1499-1503. 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. 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 . Call Carelon's Contact Center at 1-866-745-1783 Available Monday through Friday, 8 a.m. - 6 p.m. Annals Intern Med. This involves completing another sleep study, either in a lab or at home, and obtaining another prescription from your doctor. Continued use beyond the first three (3) months of therapy However, if the member is found to be using the PAP device as directed and is achieving the desired results, the DME supplier must contact the individual's physician near the end of the rental period and ask the doctor to prescribe the purchase of the device. This change was approved at the November 29, 2007 MPTAC meeting. If youre considering starting CPAP therapy, you may be wondering whether you can offset part of this cost with your insurance plan. The appropriate setting for standard CPAP treatment is determined during a titration sleep study. Chesson AL Jr, Berry RB, Pack A. It happens when the muscles in the throat relax and block the air passages to make sure . Individuals have confirmed diagnosis of OSA (confirmed via a positive facility-based PSG or with a positive home/portable sleep test); AHI greater than or equal to 15 events per hour of sleep in an asymptomatic individual. 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). Acoustic Reflection Pharyngometry (Eccovision): This is a noninvasive device that uses acoustic signal processing technology to provide a graphical representation of airway patency. Standards of Practice Committee, American Academy of Sleep Medicine. Description and validation of the apnea risk evaluation system: a novel method to diagnose sleep apnea-hypopnea in the home. Involuntary sleepiness during activities that require more active attention, such as talking or driving. Highmark Blue Cross Blue Shield has revised the coverage criteria for the Implantable Pulmonary Artery Pressure Measurement Device. The criteria for home portable monitors/sleep testing have been removed from this document and placed in CG-MED-01 Polysomnography and Home Portable Monitors. Sleep. This limits your coverage options, and you may not get the exact product you desire. 1999; 131(7):485-491. Go to www.providerportal.com Note: If you've already registered for the ProviderPortal for Blue Cross Blue Shield of Massachusetts or another insurer, you won't need to register again. Flemons WW. Am J Respir Crit Care Med. 2003; 26(6):754-760. Only 10% allow for more frequent replacement. <> You need a sleep test, diagnosis of obstructive sleep apnea, and prescription from your doctor. Sleep education. So if youre close to meeting your deductible, you may be able to acquire your CPAP device at almost no cost to you. 2004; 130(1):58-66. Oxygen saturation measures the significance of respiratory events. 2013; 9(2):125-131. Arch Dis Child. Removed ICD-9 codes from Coding section. An Independent Licensee of the Blue Cross and Blue Shield Association Page 1 of 13 Benefits Application When purchasing with an insurance provider, you are restricted to the suppliers that are covered by your insurance. 3 0 obj For the purposes of this document, the terms AHI and RDI are interchangeable, although they may differ slightly in clinical use. If you're among the 2% to 9% of adults who suffer from obstructive sleep apnea, a CPAP machine may be the solution to better sleep. Coveredsleep apneaDiagnosis Codes for Procedure Code E0601, Non-Covered Diagnosis Codes for Procedure Code E0471. In order to prove your eligibility for coverage of your CPAP device, Anthem Blue Cross will require documentation such as relevant doctors notes, sleep test results, a prescription, and may include other documents, too. On the other hand, if you have a co-insurance plan, you will also be billed monthly for the rental cost of the device, alongside your insurance company. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. 1. Learn more. This is because many insurance plans follow Medicares issued guidelines on the replacement of supplies.If your insurance coverage covers your CPAP on a rental basis, you may be wondering how long the rental period lasts. 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. . MPTAC review. The Rationale, Definitions and References have been updated. Doctors can test for sleep apnea with an overnight in-lab sleep study, also called a polysomnography, or with an at-home sleep study. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. Updated Coding section with 01/01/2009 CPT changes; removed 0089T deleted 12/31/2008. 2019; 46:151-160. 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. Thankfully, the majority of Anthem Blue Cross Blue Shield PPO and HMO plans cover CPAP therapy supplies. 1996; 11(2). BlueCross BlueShield of South Carolina Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome Policy effective 05/2022 Effective 05/2022 - 84% BlueCross BlueShield of Vermont Sleep Disorders Diagnosis and Treatment Policy effective 04/01/2022 Effective 04/01/2022 - 69% Blue Cross Blue Shield of Wyoming Internal Medical Policy Committee 11-23-2021 Revised the way the not medically necessary statements were written; added Daytime electrical stimulation (eXciteOSA) of the tongue. These include: Insurance does not typically cover any products that are considered optional. Rationale section was updated with information about acoustic pharyngometry and SNAP testing. Oral cushion for combination oral/nasal mask, replacement only, each. Breathing Problems during Sleep. Documented compliance with objective findings (i.e., compliance chip, telemonitoring, computer software) of device usage for three (3) consecutive months; The individual is experiencing success in treatment.

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