Facility-based Sleep Studies for Obstructive Sleep Apnea

This policy covers facility-based polysomnography (PSG)—including diagnostic PSG, split‑night studies, and in‑lab CPAP/BiPAP or hypoglossal nerve stimulation titration—for evaluation and management of suspected obstructive sleep apnea (OSA), with home sleep apnea testing (HSAT) allowed as an alternative in adults with a high pretest probability of uncomplicated OSA. Coverage applies to non‑Medicare members aged ≥18 who meet medical‑necessity criteria; HSAT is excluded and facility PSG required for patients with significant comorbidities (e.g., CHF NYHA III/IV, BMI ≥50, chronic pulmonary disease, chronic opioid use, neurologic/neuromuscular disorders), mission‑critical occupations, prior inadequate HSAT, and other listed limitations, and studies are subject to frequency limits.

"Facility-based polysomnography (PSG) for diagnosis of suspected obstructive sleep apnea (OSA)."