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Blue Cross Blue Shield Releases Policy Change on SRBDs

Posted by admin on May 20, 2015 1:00:00 AM

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:

* &nbsp;&nbsp;A previous home study was found to be technically inadequate.
* &nbsp;&nbsp;A previous home study failed to establish the diagnosis of OSA in a patient with a high pretest probability of OSA.
* &nbsp;&nbsp;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".

The following AAST products are available for additional education and training on HSAT, and to assist you to develop your HSAT policies and procedures:

  • Specialized Training in HSAT: Provides a comprehensive review of the role of the sleep technologist in the evaluation, testing and treatment of patients not studied using traditional laboratory testing. This program equips technologists with the skills and knowledge needed to be an integral part of an HST program.
  • 2014 Policy and Procedure Manual Templates: Templates are intended as a guide in the development of a center Policy and Procedure Manual. The manual includes a separate section for HSAT.
  • Technologists Guide to Performing Sleep Studies: Updated in 2015, this product has been expanded to include a section on home sleep apnea testing (HSAT).