Actigraphy

This policy covers actigraphy—continuous wearable activity monitoring (typically wrist‑ or ankle‑mounted devices) used to objectively assess sleep–wake patterns and physical activity for conditions such as insomnia, circadian rhythm sleep–wake disorders, sleep–wake disturbances related to medical or psychiatric conditions, restless legs/periodic limb movements, and infant movement monitoring. Limitations/requirements: actigraphy is not a stand‑alone diagnostic gold standard (polysomnography remains criterion standard), device/algorithm/settings affect accuracy and it poorly distinguishes sleep from quiet wake in disturbed sleep; it is considered experimental/investigational when used alone, coverage and billing depend on the member’s benefit plan, and actigraphy included with portable sleep testing should not be billed separately.

"Assessment of insomnia"

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