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2003, 24(2):307-313. Providers have the opportunity to review . Med Clin North Am. 1997; 20(6):423-487. If youre diagnosed with sleep apnea and require CPAP therapy, its likely your insurance will cover the cost of the device, and the replacements required thereafter. There are many different types of appliances that basically fit into one of two (2) categories, tongue retaining appliances, and mandibular repositioning appliances. While such methods do potentially identify occurrences of sleep apnea, other aspects of physiological functioning are not recorded simultaneously, thus providing an incomplete clinical picture and allowing the possibility of misdiagnosis. Clinical practice. risk of central sleep apnea, (chronic use defined as use of opioids on most days per week for greater than 3 months) Obesity hypoventilation syndrome, defined as pCO 2 greater than 45 mm Hg and pO 2 less than 60 mm Hg on arterial blood gas. Sleep Disorders. Payment will be made for the rental of a PAP device for the first three (3) months (rental period) from the original start date of therapy, when the above clinical criteria are met. Home/Portable sleep study (may also be known as NightWatch System, AutoSet Recorder, Morpheus System): A diagnostic test proposed for home use which may be self-administered or attended by a technician. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. - Your signed Assignment of Benefits Agreement, which allows us to accept payment for the equipment from your insurance. Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome We work with Anthem Blue Cross and Blue Shield PPO plans nationwide. 2002; 109(4):e69. Most insurance will not cover the following categories of products: - Cleaning Supplies: So Clean CPAP Sanitizer, Mask Wipes, etc. There is additionally a vital hereditary component to the disease. Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. Sleep. Medicare considers CPAP devices to be durable medical equipment and provides 80% coverage under Part B as long as you meet certain conditions. PDF FEP Medical Policy Manual BCN Sleep Management Program (Testing and Treatment with - BCBSM <>/Metadata 259 0 R/ViewerPreferences 260 0 R>> If the criteria are not met, the accessories are considered not medically necessary. - Travel CPAPs: Insurance will not cover a second accessory CPAP for travel.
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