UM Guidelines

	Changed Clinical Indications to the following:
	Sleep center PSG may be indicated for 1 or more of the following: ... Adult with obstructive sleep apnea, suspected, as indicated by... Initial sleep center PSG test, as indicated by... Home PSG is not appropriate, as indicated by 1 or more of the following: ... Sleep center PSG coincident with CPAP titration as split-night study ... Repeat sleep center PSG test, as indicated by... ... Home PSG is not appropriate, as indicated by 1 or more of the following: ... Sleep center PSG coincident with CPAP titration as split-night study ... Child, infant, or adolescent with obstructive sleep apnea suspected and 1 or more of the following: Initial PSG test, as indicated by... ... Appropriate test requested, as indicated by 1 or more of the following: ... Split-night study (ie, PSG with CPAP titration) for patient 12 years or older Repeat PSG indicated by... ... Appropriate test requested indicated 1 or more of the following:.. ... Split-night study (ie, PSG with CPAP titration) for patient 12 years or older ...

References

1. BlueCross BlueShield of Tennessee network physicians. April - May 2024.