Selective Desaturation Program

Selective Desaturation Program' title='Selective Desaturation Program' />Obstructive Sleep Apnea in Adults. Number 0. 00. 4Policy. Aetna considers the diagnosis and treatment of obstructive sleep apnea OSA in adults aged 1. Diagnosis. Aetna considers attended full channel nocturnal polysomnography NPSG Type I device performed in a healthcare facility medically necessary for diagnosis in members with symptoms suggestive of obstructive sleep apnea see appendix, when attended NPSG is used as part of a comprehensive sleep evaluation, and member has one or more of the following indications for attended NPSG Member has at least one of the following comorbid medical conditions that degrade the accuracy of portable monitoring moderate to severe pulmonary disease for example, COPD or ashma with nocturnal oxygen use or daytime hypercapnea with documented arterial blood gasses showing p. O2 less than 6. 0 or p. CO2 greater than 4. Parkinsons disease,  spina bifida, myotonic dystrophy, amyotrophic lateral sclerosis,stroke with residual respiratory effects,epilepsy,congestive heart failure NYHA class III or IV or LVEF less than 4. BMI greater than 4. BMI greater than 3. PCO2 greater than 4. BMI greater than 3. Member has one or more of the following comorbid sleep disorders periodic limb movement disorder involuntary, jerking movements of the legs during sleep causing excessive daytime sleepiness EDS due to sleep fragmentation,parasomnias that are unusual or atypical because of the individuals age at onset, the time, duration or frequency of occurrence of the behavior including, but not limited to nocturnal seizures, psychogenic dissociative states, REM sleep behavior disorder, sleep talking andor confusional arousals,narcolepsy,central sleep apnea or complex sleep apnea or. Member has negative or technically inadequate portable monitoring results or. Vst Plugins For Nuendo 4. Member has low pretest probability of obstructive sleep apnea normal BMI less than 3. Selective Desaturation Program' title='Selective Desaturation Program' />Functional uses flavor and fragrance agents. Has a aldehydic type odor and an aldehydic type flavor. AKVIS Coloriage manipulates colors of an image from colorizing old black and white photos from your family archive to replacing colors in your color photos. AKVIS. Nationally Accredited Continuing Education Courses for Psychologists, Social Workers, Counselors, and Marriage and Family Therapists. Mallampati score 1 or 2, no snoring, and normal neck circumference less than 1. Member lacks the mobility or dexterity to use portable monitoring equipment safely at home. Note Where attended NPSG is indicated, a split night study NPSG is considered medically necessary, in which the final portion of the NPSG is used to titrate continuous positive airway pressure CPAP, if the Apnea Hypopnea Index AHI is greater than 1. An additional full night CPAP titration NPSG is considered medically necessary only if the AHI is less than or equal to 1. III below. Aetna considers unattended home sleep studies using any of the following diagnostic techniques see appendix for definition of device types medically necessary for members with symptoms suggestive of OSA see appendix when the home sleep study is used as part of a comprehensive sleep evaluation Sleep monitoring using a Type II device or. Sleep monitoring using a Type III device, or. Sleep monitoring using a Type IVA device, measuring airflow and at least 2 other channels and providing measurement of apnea hypopnea index AHI or Sleep monitoring using a device that measures 3 or more channels that include pulse oximetry, actigraphy, and peripheral arterial tone e. Watch PAT device. Note Sleep studies using devices that do not provide a measurement of apnea hypopnea index AHI and oxygen saturation are considered not medically necessary because they do not provide sufficient information to prescribe treatment. Examples include the Biancamed Sleep. Minder, SNAP testing with fewer than three channels, and the Sleep. Image Sleep Quality Screener. Note that the Apnea. Link does not meet criteria as a covered type IV device because it does not measure airflow however, the Apnea. Link Plus records 5 channels, including airflow, and meets criteria for a covered sleep study device. Repeat home sleep testing on multiple consecutive nights has no proven value. Attended full channel nocturnal polysomnography NPSG Type I device performed in a healthcare facility is considered medically necessary for persons diagnosed with obstructive sleep apnea who have any of the following indications for attended NPSG To titrate CPAP in persons diagnosed with clinically significant OSA for whom in laboratory NPSG was medically necessary, but who were unable to undergo a split night study because they had an insufficient AHI less than 1. NPSG or  To titrate CPAP in persons with clinically significant OSA for whom in laboratory NPSG was medically necessary, and who underwent a split night study that did not abolish the vast majority of obstructive respiratory events or. To monitor results from CPAP in persons with OSA who have persistent significant symptoms disturbed sleep with significant arousals despite documented AHI less than 5 on CPAP and documented compliance with CPAP CPAP used for 7. To confirm diagnosis of obstructive sleep apnea prior to surgical modifications of the upper airway. It may be necessary to perform repeat sleep studies up to twice a year for any of the following indications Note where repeat testing is indicated, attended full channel nocturnal polysomnography NPSG Type I device performed in a healthcare facility is considered medically necessary for persons who meet criteria for attended NPSG in section I above in all other cases, unattended home sleep studies are considered medically necessary To determine whether positive airway pressure treatment i. CPAP, bilevel positive airway pressure Bi. PAP, demand positive airway pressure DPAP, variable positive airway pressure VPAP, or auto titrating positive airway pressure Auto. PAP continues to be effective or To determine whether positive airway pressure treatment settings need to be changed or. To determine whether continued treatment with positive airway pressure treatment is necessary or. To assess treatment response after upper airway surgical procedures and after initial treatment with oral appliances. Note A home sleep study is performed over multiple nights with a single interpretation is considered a single sleep study for purposes of reimbursement. Video EEG NPSG NPSG with video monitoring of body positions and extended EEG channels is considered medically necessary to assist with the diagnosis of paroxysmal arousals or other sleep disruptions that are thought to be seizure related when the initial clinical evaluation and results of a standard EEG are inconclusive. Aetna considers any of the following diagnostic techniques experimental and investigational in members with symptoms suggestive of OSA because their effectiveness for this indication has not been established Acoustic pharyngometry. See CPB 0. 33. 6 Acoustic Pharyngometers and SNAP Testing Systemuyftcvyuffwtzvdutrywwxtx or Actigraphy testing when used alone. Actigraphy, which consists of a small portable device that senses physical motion and stores the resulting information, has been used in research studies for the evaluation of rest activity cycles. This technique, when used alone single channel study, has not been validated as a method of diagnosing OSA. See CPB 0. Actigraphy and Accelerometry or Cephalographic X rays for diagnosis of OSA. A single panoramic x ray of the jaws and a lateral cephalometric x ray are considered medically necessary for the evaluation for an oral appliance for OSA.