Sleep Apnea Diagnosis and Treatment in Adults

Coverage decision: Covered with conditions

Condition of Coverage

Background Policy Information

The State Health Technology Clinical Committee (HTCC) reviewed sleep apnea diagnosis and treatment in adults on March 16, 2012. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that sleep apnea diagnosis and treatment in adults are covered benefits with conditions. Complete information on this HTCC determination is available here: http://www.hca.wa.gov/hta/Pages/Forms/HTA_Findings.aspx.

Implementation of Determination

Diagnosis and treatment of sleep apnea may be used only for care of a condition accepted on the claim. Sleep apnea is unlikely to be related to any occupational injury or disease and is therefore not expected to be an accepted condition on an L&I claim. All requests require prior authorization.

For State Fund Claims

All requests will be reviewed by L&I’s occupational nurse consultant and claims manager.

  • Complete the Preauthorization Form and fax to:(360) 902-4567.
  • For additional information contact the claims manager.
    • To obtain the claims manager’s phone number call 1-800-831-5227
    • Attending provider, concurrent care provider or IME log into the Claims & Account Center (CAC)
For Self-Insured Claims

Please contact the self-insured employer (SIE) or their third party administrator (TPA). For a list of SIE/TPAs, go to:
http://www.Lni.wa.gov/ClaimsIns/Insurance/SelfInsure/EmpList/Default.asp

Billing Codes

CPT ® Codes: 95800-95811
HCPCS Codes: G0398, G0399 and G0400, and numerous DME supply codes.


For more information:
Contact information.

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