Sleep Management Guidelines

Covers home sleep testing, facility polysomnography, MSLT/MWT, PAP initiation/titration (E0601, E0470, E0471) and selected oral appliances for obstructive/central sleep‑disordered breathing when strict clinical, physiologic and documentation criteria are met; excludes investigational/non‑covered items such as PAP‑NAP, actigraphy, Provent, Winx, and unlisted PAP codes (CPT 94799/E1399) (CMS rules govern Medicare). Key requirements: a current comprehensive clinical evaluation (≤60 days) and required questionnaires (ESS, Berlin, STOP‑BANG or ISI) or proxy, diagnostic thresholds (AHI/RDI/REI ≥15, or ≥5–14.9 with symptoms/comorbidities), HST limited to high pretest probability patients without specified comorbidities, MSLT must immediately follow PSG, MWT requires documented treatment and PAP compliance, and PAP device initiation/replacement/continued coverage requires objective compliance (≥70% nights, ≥4 hrs/night for a consecutive 30‑day period within the first 3 months) and device nonrepairability/out‑of‑warranty for replacements.