Sleep Management Guidelines

Allows home sleep testing for adults with high pre-test probability who can safely use equipment and have no comorbid indications, requires in‑lab PSG for children, complex comorbidities, inconclusive HST, or when specific therapies (bi-level/ASV, pre/post‑implant testing) are indicated; device- and procedure-specific therapies (PAP modes, oral appliances for adults, surgery, hypoglossal/phrenic nerve stimulation) are covered only with specified criteria, while pediatric oral appliances, oral appliances to prevent TMJ, and other experimental therapies are excluded/investigational. Key requirements include a documented clinical evaluation within 60 days and a validated sleep questionnaire, diagnostic thresholds (AHI/RDI/REI ≥15 or 5–14 with symptoms/comorbidities), HST only if all three HST criteria are met, split‑night/MSLT timing rules, PAP compliance of ≥70% of nights at ≥4 hours/day over 30 consecutive days for authorization/continuation/replacement, and specific anatomy, BMI, age, central‑apnea, and documentation/warranty requirements for surgical or implantable devices.