Effective April 1, 2025: Sleep Studies Clinical Policies
Date: 12/27/24
Superior HealthPlan has added/updated certain policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on April 1, 2025.
For more information, please review Effective April 1, 2025: Transition of Utilization Review for Sleep Studies.
POLICY | APPLICABLE PRODUCTS | NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS |
Facility-based Sleep Studies for Obstructive Sleep Apnea (CP.MP.248) | Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter | The policy criteria are derived from a combination of the American Academy of Sleep Medicine (AASM) guidelines, CMS local coverage determinations, and systematic reviews which state that while PSG is currently considered the gold standard diagnostic test for OSA, home sleep apnea testing (HSAT) is an alternative method used and may be less costly and more efficient in some adult populations |
Multiple Sleep Latency Testing (CP.MP.24)
| Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter | Medical necessity criteria for multiple sleep latency testing (MSLT) which objectively measures an individual’s tendency to fall asleep and is a component of the routine evaluation for suspected narcolepsy or idiopathic hypersomnia |
To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.
Prior to updates, Medical Clinical policies are reviewed and approved by the Utilization Management Committee.
For questions or additional information, contact Superior HealthPlan Prior Authorization department at 1-800-218-7508.