Hypopnea Scoring Alignment

Payer Alignment with AASM Recommended Hypopnea Scoring Criteria

AASM’s position statement Polysomnography for Obstructive Sleep Apnea Should Include Arousal-Based Scoring: An American Academy of Sleep Medicine Position Statement, was published in the July 2018 issue of the Journal of Clinical Sleep Medicine. This position statement emphasizes the position of the AASM that the RECOMMENDED AASM Scoring Manual scoring criteria for hypopneas, which includes diminished airflow accompanied by either an arousal or ≥ 3% oxygen desaturation, in adults, be used to calculate the apnea hypopnea index (AHI); the sleep study metric used to measure the severity of sleep apnea. For a more detailed explanation, please click here. For reference, the table below lists which private payer policies align with AASM’s RECOMMENDED hypopnea scoring criteria.

Click here to download and personalize a template letter to request that payers consider updating the AHI definition to the one currently recommended by the AASM.

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Aetna X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Anthem Blue Cross Blue Shield

  • Colorado
  • Connecticut
  • Indiana
  • Kentucky
  • Maine
  • Missouri
  • Nevada
  • New Hampshire
  • Ohio
  • Virginia
  • Wisconsin
 X X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
  • Blue Cross Blue Shield
    • Alabama
    • Florida
    • Illinois (HCSC)
    • Kansas
    • Kansas City
    • Louisiana
    • Michigan
    • Mississippi
    • Montana
    • New Mexico
    • North Carolina
    • Oklahoma
    • South Carolina
    • Texas
    • Vermont
 X X
  • Blue Cross Blue Shield
    • North Carolina
    • Western New York
 X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Blue Cross Blue Shield Minnesota X X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Blue Cross Blue Shield Massachusetts X X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Blue Shield of California X X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Capital Blue Cross X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
CareCentrix X X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Cigna X X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Connecticare X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Government Employees Health Association, Inc. X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Hawaii Medical Service Association X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Highmark Blue Cross Blue Shield X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Horizon Blue Cross Blue Shield of New Jersey X X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
Medica X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
National Imaging Associates Magellan X X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
  • Premera Blue Cross Blue Shield
    • Alaska
    • Washington (excludes Clark County)
 X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
  • Regence BlueCross BlueShield
    • Idaho
    • Select counties of Washington
 X X

Private Payer ≥ 3% O2 Desaturation or
Arousal
(RECOMMENDED)		 4% O2
Desaturation
United Healthcare X

Please note that this is not a complete list of private payers, but will be updated on an annual basis, as policies are reviewed. AASM members may send policies to coding@aasm.org for review.

Additional Resources

Email us your Sleep Coding/Reimbursement questions!

AASM Scoring Manual

Payer Policy Scorecards

Coding FAQs