The AASM has been reaching out to Blue Shield of California leadership over the past two months regarding the payer’s denial of reimbursement for positive airway pressure (PAP) therapy when a device with only one respiratory monitoring belt is used in performing the patient’s diagnostic sleep study. However, no response has been received to date. Additionally, despite the payer’s “Medical Management of Obstructive Sleep Apnea Syndrome” policy being updated as recently as June 2023, there has been no update to the original policy language, which incorrectly quotes AASM clinical practice guidelines and fails to reference the AASM Manual for the Scoring of Sleep and Associated Events, which specifically states that single thoracoabdominal RIP belts are acceptable.
Therefore, all AASM members impacted by this policy are urged to download and personalize this template letter, which can be sent to Medpolicy@blueshieldca.com. This template letter will also be available for download from the Payer Advocacy Take Action page on the AASM website.
The AASM health policy team will continue to follow up with Blue Shield of California regarding this issue. Members are encouraged to send payer policy questions to coding@aasm.org.
