This CPB is revised to state that estimates of AHI or RDI that only count events during periods of REM sleep (and exclude periods of non-REM sleep from the calculation) are not acceptable for use in determining whether the member meets medical necessity criteria.

This CPB is revised to state that BiPAP without a backup rate feature, DPAP, and VPAP are considered medically necessary DME for members who are intolerant to CPAP or AutoPAP, or for whom CPAP or AutoPAP is ineffective. (The previous version of the CPB only listed intolerance as an indication for these devices.)

This CPB is revised to state that mndibular advancement oral appliances to reduce upper airway collapsibility and tongue retaining devices are considered medically necessary as first line treatment for mild to moderate obstructive sleep apnea (AHI or RDI less than 30) in members who meet medical necessity criteria.

This CPB is revised to state that replacement of positive airway pressure devices or oral appliances is considered medically necessary at the end of their 5-year reasonable useful lifetime (RUL).  Replacement of these items is considered medically necessary prior to the end of the 5-year RUL in cases of irreparable damage due to a specific accident or to a natural disaster (e.g., fire, flood).

This CPB is revised to note that all follow-up care, including fitting, adjustments, modifications, professional services (not all-inclusive) required during the first 90 days after provision of the oral appliance are considered to be included in the payment for device.

This CPB has been revised to state that the following are considered experimental and investigational: (i) the SleepStrip for the diagnosis of obstructive sleep apnea (OSA), (ii) the Encore tongue base suspension, and (iii) Winx therapy system/oral pressure therapy for the treatment of OSA. This CPB is revised to state that the following positive airway pressure supplies are considered not medically necessary convenience items: (i) positive airway pressure bed pillows; (ii) batteries for positive airway pressure devices; (iii) DC adapters for positive airway pressure devices.

This CPB is revised to list the usual medically necessary quantity of supplies for positive airway pressure devices. This CPB is revised to note that Aetna follows Medicare DME MAC rules for the medically necessary quantity of tracheostomy supplies for OSA and other indications.