Medical Management of Sleep Related Breathing Disorders

This policy covers medical management of sleep‑related breathing disorders, including APAP for pressure titration, CPAP, bilevel PAP (for obstructive and established central sleep apnea), oral intraoral appliances, and associated in‑lab or home titration and re‑titration studies. Coverage is primarily for adults with clinically significant OSA (AHI/RDI/REI ≥15, or ≥5 with symptoms/comorbidities) and select pediatric indications per criteria, but requires documented home or lab sleep testing and titration demonstrating benefit; APAP is limited to adults, bilevel PAP generally requires prior CPAP failure or demonstrated superiority in the lab, and certain devices/uses (e.g., some oral appliance technologies or pediatric use outside craniofacial anomalies) are considered experimental or not covered.

"Auto-adjusting positive airway pressure (APAP) for titration of pressure in the management of sleep-related breathing disorders."