Sleep Studies: Resources
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Shared Resources
Resources for services managed by Carelon
- Frequently asked questions about Carelon: for cardiology, radiology (high technology) and sleep studies (in lab)
— Answers to questions about authorization requirements for cardiology services, high-tech radiology services and in-lab sleep studies
Additional Resources
- Sleep studies: For prior authorization determinations —Includes information about utilization management programs
- Procedure codes for which providers must request prior authorization — See this document to determine which procedure codes require prior authorization
BCN Resources
Positive airway pressure devices for the treatment of obstructive sleep apnea
BCN provides coverage for PAP devices for members who meet medical necessity criteria. The guidelines for initial coverage are found in our Sleep Disorders — Diagnosis and Medical Management medical policy. (To access this policy, open the Medical Policy Router Search page on bcbsm.com and enter the name of the policy of the policy in the Policy/Topic Keyword field.)
Members who use PAP devices must show they're complying with their treatment recommendations to use the device for longer than 90 days. This applies to requests for clinical review for BCN commercial and BCN Advantage members. For members who meet the initial criteria for these devices, Northwood, Inc., BCN's durable medical equipment benefit manager, will authorize use of the devices for a three-month period.
Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.
Frequently accessed documents
Additional resources
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