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Date Printed: August 23, 2017: 05:51 AM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

Subject: Sleep Testing

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This medical coverage guideline is not an authorization, certification, explanation of benefits, or a guarantee of payment, nor does it substitute for or constitute medical advice. All medical decisions are solely the responsibility of the patient and physician. Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. This medical coverage guideline applies to all lines of business unless otherwise noted in the program exceptions section.

 

DESCRIPTION

Sleep testing helps determine if you have a sleep disorder, such as sleep apnea or insomnia. It can also measure how effective a therapy is to treat a sleep disorder.

There are two basic types of sleep testing. Sleep studies measure certain aspects of sleep. Sleep studies are not as complex or involved as a polysomnography study. Polysomnography is more complex and is performed overnight in a sleep laboratory. This test studies many aspects of sleep. Special monitors for breathing, brain waves, blood oxygen, eyelid movements, muscle movements, and heart rhythm are used. Both types of testing are often performed in a special facility, although some types of sleep testing can be done at home.

Once the testing is completed, your results will be scored. Your doctor will consider the results. If your score is high enough, your doctor may diagnose you with a sleep disorder and decide on a course of treatment.

Visit the Clinical View of this guideline for specific coverage information.

Visit WebMD for more information on sleep testing.

COVERAGE

 

Note: For all medical decisions about this service, Florida Blue uses the Position Statement in the Clinical View of this medical coverage guideline. To make the best decision for your health needs, talk to your doctor. The services covered vary from health plan to health plan. Refer to your health plan contract for complete information about your coverage.

 

Sleep studies that may be covered if certain requirements are met include:

• Polysomnography

• Home Sleep Testing (HST)

• Multiple Sleep Latency Testing (MSLT)

• Maintenance of Wakefulness Test (MWT)

Visit the Clinical View of this guideline for specific coverage information.

PROGRAM EXCEPTIONS

• Federal Employee Program (FEP): Certain exceptions apply.

• State Account Organization (SAO): Certain exceptions apply.

• Medicare Advantage products: Certain exceptions apply.

Visit the Clinical View of this guideline for more coverage information.

Refer to your health plan contract for complete information about your coverage.

Date Printed: August 23, 2017: 05:51 AM