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PW_E192104
Sleep Testing and Therapy Services  
Empire will introduce a new specialty benefit management program for sleep testing and therapy services performed on or after March 1, 2013. This new program will consider the medical necessity of sleep testing and therapy services, including the need for use of a facility test versus doing the test in the home. 
 
Prior Authorization for Sleep Testing and Therapy 
Please contact AIM to obtain an order number for the following elective services or supplies scheduled on or after March 1, 2013.  
Home sleep test (HST)
In-lab sleep study (PSG)
Titration study
Initial treatment order (APAP, CPAP, BPAP and oral devices, appliances and related supplies)
Ongoing treatment order (APAP, CPAP, BPAP and oral devices, appliances and related supplies)
 
Services performed in conjunction with emergency room services, inpatient hospitalization, or urgent care facilities are excluded. For therapy services, members must meet usage criteria for the continued rental of equipment and replacement of supplies.  
Prior authorization for sleep testing and therapy services applies to all Empire members except the following:  
Federal Employee Program (FEP)
Empire BlueCross BlueShield secondary coverage, including those whose primary insurance carrier is Medicare
Medicare Advantage - MediBlue
Child Health Plus Members
Plans that do not participate in High End Radiology programs
 
Please note that the prior authorization requirement will apply for Healthy New York members only for sleep studies. 
To verify prior authorization requirements for BlueCard® business, visit us online and click the Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements box on the left-hand side of the Provider Home page at empireblue.com. You may also call 800-676-BLUE (2583). 
To submit a request for sleep testing or therapy services, visit AIM online at www.aimspecialtyhealth.com/gowebsleepand select “Empire BCBS” from the drop-down menu to log in. You may also call AIM toll-free at 877-430-2288, Monday – Friday, 8:00 a.m. – 6:00 p.m. ET.  
 
 
New Clinical Guidelines for Sleep Management 
Effective March 1, 2013, the sleep management program will follow AIM Obstructive Sleep Apnea Diagnostic & Treatment Management Clinical Guidelines. The clinical guidelines for sleep can be accessed on AIM’s home page at www.aimspecialtyhealth.com.  
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