Sleep Disorder Management (facility sleep studies, PAP devices, oral appliances)
Administrative guideline governing clinical review processes for facility sleep studies, positive airway pressure (PAP) devices and related supplies, and oral appliances performed or reviewed by Carelon Medical Benefits Management for Premera members.
Related policy 7.01.101 was replaced with 7.01.554 Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome.
Name change from AIM Specialty Health to Carelon Medical Benefits Management reflected with URL updates and no content changes.
Coverage Criteria
This medical policy does not apply to Medicare Advantage.
Provider Submission & Review Requirements
Portal-based clinical review required
Carelon Medical Benefits Management conducts clinical reviews for facility sleep studies, PAP devices (APAP, CPAP, BPAP), adherence monitors for replenishment of related supplies, and oral appliances; providers must obtain review/authorization through Carelon prior to services as specified in the portal and guidelines.
Device-type review per Carelon guidelines
Carelon’s Sleep Disorder Management Clinical Guidelines explicitly cover device types including auto‑titrating positive airway pressure (APAP), continuous positive airway pressure (CPAP), bi‑level positive airway pressure (BPAP), and related PAP supplies; device selection and related review follow those guidelines.