Payer Policy Scorecards
Payer policy scorecards were created to evaluate how effective payer policies are at establishing appropriate coverage for diagnostic sleep testing services. The intent of the scorecards is to encourage insurers to adopt evidence-based policies that support patient safety and delivery of high-quality care.
The following scorecards for several major payers are based on the careful review of their policies by the AASM Payer Policy Review Committee, and were sent to each payer in advance for comment before posting online.
Diagnostic Testing for Obstructive Sleep Apnea
The AASM Payer Policy Review Committee based the Diagnostic Testing for Obstructive Sleep Apnea (OSA) scorecard on the AASM’s 2017 clinical practice guideline on diagnostic testing for OSA. The scorecard’s nine criteria correspond to the clinical practice recommendations contained in the guideline. The Committee also developed a Template Policy, intended to serve as an additional resource, which exemplifies a policy that is in alignment with the AASM guideline on Diagnostic Testing for adult OSA.
Click here to access an initial analysis of the initiative Addressing Gaps Between Payer Policies and AASM Clinical Practice Guidelines Using Scorecards, published in the May 2020 issue of the Journal of Clinical Sleep Medicine.
AASM members are encouraged to email payer policies related to diagnostic testing for OSA to coding@aasm.org.
Active Policies
Aetna
Obstructive Sleep Apnea in Adults
AIM Specialty Health
Sleep Disorder Management – Diagnostic and Treatment Management
Used by Premera Blue Cross, Blue Cross Blue Shield of Massachusetts, and Independence Blue
Blue Cross Blue Shield Federal Employee Program
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
Blue Cross Blue Shield of Florida
Sleep Testing
BlueCross BlueShield Kansas
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
Blue Cross Blue Shield of Michigan and Blue Care Network
Sleep Disorders, Diagnosis and Medical Management
Blue Cross Blue Shield of Montana
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
BlueCross BlueShield of North Carolina
Sleep Apnea: Diagnosis and Medical Management
Blue Cross Blue Shield of Wyoming
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
Blue Shield of California
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
Capital BlueCross
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
CareFirst BlueCross BlueShield
Sleep Disorders
Cigna
- Sleep Testing Services Policy effective 06/15/2020
- Sleep Testing Services Policy effective 06/15/2019
- OSA Diagnosis and Treatment Services Policy effective 11/15/2016
ConnectiCare
Obstructive Sleep Apnea Diagnosis and Treatment
eviCore
- Sleep Apnea and Clinical Treatment Guidelines Policy effective 02/14/2020
- Sleep Apnea and Treatment, v1.0.2019 Policy effective 02/15/2019
- Sleep Apnea and Treatment, v6.0.2018 Policy effective 05/17/2018
- Sleep Apnea and Treatment, v5.0 Policy effective 06/05/2017
Used by Blue Cross Blue Shield of Minnesota and Blue Cross Blue Shield of Arizona
Highmark Blue Cross Blue Shield of Pennsylvania
Diagnosis and Treatment of Obstructive Sleep Apnea for Adults
Horizon Blue Cross Blue Shield of New Jersey
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
Humana
Sleep Studies, Adult
National Imaging Associates, Inc.
Nocturnal Polysomnography & Home Sleep Test (2 policies)
Used by Harvard Pilgrim
Priority Health
Obstructive Sleep Apnea Including UPPP and LAUP
United HealthCare
Attended Polysomnography for Evaluation of Sleep Disorders
Retired Policies
Blue Cross Blue Shield of Arizona
Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome
* Retired – defer to eviCore
Blue Cross Blue Shield of Massachusetts*
Polysomnography and Home Sleep Testing
* Retired – defer to AIM Specialty Health
Blue Cross and Blue Shield of Minnesota*
Sleep Disorder Testing in Adults
* Retired – defer to eviCore
Excellus Blue Cross Blue Shield
Sleep Studies
Harvard Pilgrim*
- Sleep Studies Policy effective 12/03/2018
- Sleep Study, Attended (Nocturnal Polysomnography) Policy effective 09/01/2017
* Retired – defer to National Imaging Associates, Inc.
Independence Blue
Sleep Disorder Testing and Positive Airway Pressure Therapy
* Retired – defer to AIM Specialty Health
Premera Blue Cross
Polysomnography and Home Sleep Study for Diagnosis of Obstructive Sleep Apnea
* Retired – defer to AIM Specialty Health