PRV1_0119_ProviderManual-Commercial.pdf

Nocturnal polysomnogram psg is a detailed study

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• Nocturnal Polysomnogram (PSG) is a detailed study, usually done in a hospital setting with a technician present throughout, and includes monitoring by electroencephalography (EEG), electromyography (EMG), electro-oculography (EOG), oral and nasal airflow, chest movements, oxygen saturation, heart rate and rhythm, and measuring of snoring intensity. This test is considered to gold standard for diagnosing sleep apnea and distinguishing obstructive from nonobstructive sleep apnea. Multiple Sleep Latency Tests (MSLT) measures the time it takes for the subject to fall asleep and is used primarily in cases of suspected narcolepsy. • Actigraphy is a method of monitoring motor activity with a portable device designed to be used while patients are sleeping. Absence of movement is consistent with sleep. Actigraphy is used either alone or with PSG to diagnose sleep disorders.
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Section 6 | Medical Management 31 Home Sleep Study Testing (HST) is done using unattended portable monitoring devices. While the currently accepted method for definitive diagnosis of OSA is full polysomnography done with a qualified sleep laboratory technician in attendance, home sleep studies using unattended portable devices may be appropriate in patients with suspected OSA when an in-laboratory polysomnogram is not possible by virtue of immobility, safety, or critical illness. Home sleep studies are not considered appropriate for patients with chronic obstructive pulmonary disease or for those suspected of having other sleep complications, such as central apnea, periodic leg movement or narcolepsy. Criteria: Sleep Studies Some group contracts require that sleep studies be ordered by a pulmonologist, neurologist, otolaryngologist, or certified sleep medicine specialist. Sleep studies may also be ordered by family practice or internal medicine physicians (and nurse practitioners or physicians assistants working with the family or internal medicine physicians) despite not being specified in the contract language. Preauthorization Requirements Preauthorization is required for coverage of oral appliances for the treatment of sleep apnea. CPAP/ BIPAP devices do not require prior authorization for the initial 3 month rental and convert to purchase. CPAP/BIPAP rental extension, repairs and replacement greater than $800 do require a prior authorization. Requests for coverage of services for obstructive sleep apnea (OSA) treatment will be reviewed by the criteria below. Coverage Guidelines: Nonsurgical Treatment of Sleep Disorders Obstructive sleep apnea can be treated both surgically and nonsurgically. Nonsurgical treatment options include: • Continuous positive airway pressure (CPAP) • Bilevel positive airway pressure (BiPAP) • Oral appliances Criteria for Coverage of Nonsurgical Treatment of Sleep Disorders CPAP and BIPAP includes: Auto-titrating Positive Airway Pressure (APAP) and Adaptive Servo- Ventilation (ASV).
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  • Winter '16
  • Dr. Vincent Onyebuchi
  • PacificSource

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