Diagnosis of Obstructive Sleep Apnea Syndrome

This policy covers diagnostic evaluation for obstructive sleep apnea (OSA), including supervised in‑lab polysomnography and unattended home sleep apnea testing (HSAT) using Type II/III devices or combinations of peripheral arterial tone, actigraphy, ECG/heart rate and oximetry, with repeat HSAT allowed for assessing surgical/oral appliance efficacy or major weight/symptom changes. Coverage is primarily for adults with symptoms suggestive of OSA (e.g., witnessed apneas, excessive daytime sleepiness, habitual snoring, obesity [BMI>30], hypertension, craniofacial abnormalities); pediatric patients (<18) require supervised laboratory studies, HSAT is only covered when policy criteria are met (facility PSG is not necessary if HSAT is appropriate), and HSAT is not appropriate or covered with comorbidities that alter ventilation (e.g., heart failure, neuromuscular disease, chronic lung disease, obesity hypoventilation syndrome or BMI ≥40) or when non‑specified/Type IV devices or unsupported repeat tests are used.