CG-DME-08 Infant Home Apnea Monitors

This policy addresses infant home cardiorespiratory (apnea) monitors. Coverage is medically necessary for infants who have had a BRUE (monitor until event-free for 2–3 months); have tracheostomies or airway-compromising craniofacial anomalies; have neurologic or metabolic disorders affecting respiratory control; or have chronic lung disease (e.g., bronchopulmonary dysplasia), particularly when requiring supplemental oxygen, CPAP, or mechanical ventilation. Home apnea monitoring is not covered for infants who do not meet these criteria.

"Home cardiorespiratory (that is, apnea) monitoring is consideredmedically necessaryin any of the following infants:"

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