Sleep Management Guidelines

Covers diagnosis and treatment of sleep apnea and related disorders — including HST, in‑lab PSG (diagnostic, split‑night, titration), MSLT, CPAP/APAP, BiPAP, ASV, actigraphy and related supplies — when objective criteria are met (OSA defined as AHI ≥15 or AHI 5–14 with daytime symptoms or specified comorbidities); PSG is required for children, suspected narcolepsy/central/complex apnea, significant cardiopulmonary/neuromuscular comorbidity or when HST is contraindicated, while home testing in children and numerous other therapies/codes are investigational/excluded. Key requirements: a comprehensive clinical evaluation within 60 days plus a sleep questionnaire (or proxy), submission of objective test results, documented patient/supplier education, and demonstrated PAP compliance (≥70% of nights and ≥4 hours/night over a consecutive 30‑day period within the first 3 months) with specific physiologic/laboratory thresholds (PaCO2, oximetry, central apnea indices) required for BiPAP/ASV and for equipment replacement.