Prior Authorization
Prior authorization is a cost-control practice used by payers to require preapproval for specific medical services, prescriptions, or supplies, creating an additional administrative burden for providers. This practice affects providers and beneficiaries of both public and private payers and can delay patient care and create additional administrative burden for providers.
The AASM has developed the Prior Authorization Toolkit to provide sleep medicine practices with standardized resources to efficiently navigate payer prior authorization requirements. This toolkit promotes timely access to care, reduces administrative burden, and supports compliance with federal and state-level regulations.
The AASM also continues to advocate for prior authorization reform by submitting responses to CMS proposed rules that would change Medicare prior authorization policies and processes. AASM comments include recommendations on:
- Reducing administrative burdens
- Streamlining approvals for routine diagnostic testing
- Exempting high-risk patients from prior authorization requirements
- Standardized prior authorization criteria across payers
- Support for increased interoperability to increase prior authorization data sharing and reduce response times
Review the most recent proposed rule response here.
The AASM also supports the American Medical Association’s efforts to advocate for changes to prior authorization requirements and policies, by requesting that payers align with the Prior Authorization and Utilization Management Principles, and also make the following changes:
- Implement long-term authorizations for chronic and terminal conditions to eliminate the need for repeat reviews
- When a prior authorization decision is reached for a chronic or terminal condition by one payer, allowing that decision to be shared and remain valid if the patient changes payers.
Review a snapshot of major payers for a glimpse at which diagnostic sleep studies require prior authorization.*
| Private Payer Prior Authorization Requirements | |||||
|---|---|---|---|---|---|
| Home Sleep Apnea Tests (HSAT) | Polysomnography (PSG) | Actigraphy | Multiple Sleep Latency Test (MSLT) | Maintenance of Wakefulness Test (MWT) | |
| Aetna | N | Y | Y | Y | Y |
| AIM Specialty Health | Y | Y | Y | Y | Y |
| Anthem | Y | Y | Y | Y | Y |
| Centene | Y | Y | Y | Y | Y |
| Cigna | N | Y | N | Y | Y |
| CVS Health** | N | N | N | N | N |
| HCSC | Y | Y | Y | Y | Y |
| Humana | N | Y | N | Y | Y |
| Molina Health | Y | Y | Y | Y | Y |
| United Healthcare | N | Y | N | Y | Y |
| United Healthcare Oxford | Y | Y | Y | Y | Y |
* This information was last revised in May 2026.
** Prior authorization required for repeat studies.
CMS regularly updates its prior authorization policies and the Master List of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items that could potentially be subject to a face to face encounter, a written order prior to delivery, and/or prior authorization requirements.
CMS most recently finalized updates to the Master List in the January 13, 2026 Federal Register, with changes effective April 13, 2026. As of that date, the Master List includes 530 HCPCS items. Of these, 74 items are included on the Required Prior Authorization List, and 83 items are included on the Required Face to Face Encounter and Written Order Prior to Delivery List.
View CMS prior authorization resources via the links below.
- Prior Authorization and Pre-Claim Review Initiatives
- Prior Authorization Process for Certain Hospital Outpatient Department (OPD) Services Frequently Asked Questions (FAQs)
- Prior Authorization and Pre-Claim Review Overview
General questions about prior authorization can be sent to coding@aasm.org. For questions about requirements for specific payers, please contact the payer directly.