Apnea Monitors for Infants

Aetna covers apnea monitors as DME for infants under 12 months with documented apnea or specified risk factors (confirmed pertussis at discharge, apnea with bradycardia <80 bpm, marked hypotonia, or oxygen desaturation <90%/cyanosis/pallor). Coverage is time‑limited — pertussis up to 1 month; most indications until the infant is event‑free for 6 weeks; apnea of prematurity until past 43 weeks post‑conception and event‑free 6 weeks — continued use beyond these limits or past infancy requires supporting documentation.

"Medical necessity of some indications (neurologic/metabolic disorders affecting respiratory control; tracheostomies/anatomic abnormalities) is reviewed on an individual case basis — not automatical..."

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