Sleep Management Guidelines
EVICORE-SLEEP_FINAL
Covers appropriate use of HST, in‑lab PSG (including split‑night, titration), MSLT/MWT, PAP therapies (E0601, E0470/E0471), oral appliances (E0486) and specified supplies, while excluding PAP‑NAP (CPT 95807), actigraphy and devices like Provent/Winx as investigational, and considering home testing investigational in children (<18). Key requirements: a comprehensive clinical evaluation within 60 days plus a sleep questionnaire (ESS, Berlin, STOP‑BANG or ISI); OSA defined as AHI/RDI/REI ≥15 or 5–14.9 with symptoms/comorbidities; HST limited to patients with high pretest probability who can self‑administer and is inappropriate for listed comorbidities (e.g., BMI>45/OHS, severe pulmonary/neuromuscular disease, CHF LVEF<45%); PAP initiation/continuation/replacement requires objective adherence (≥70% nights, ≥4 hrs/night over 30 days) and specified supply/replacement frequency limits.
"Split night study (CPT95811) is appropriate when Apnea Hypopnea Index (AHI) is 3E=15/hr for 3E=2 hours of testing and 3E=3 hours of sleep time remain for PAP titration."