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AIM Specialty Health® (AIM) Precertification/Preapproval for Sleep Disorder Testing; Positive Airway Pressure (PAP) Titration; and APAP, BiPAP, and CPAP Machines and Replacement Supplies for Medicare Advantage Members
For most members enrolled in the Company’s Medicare Advantage HMO and PPO products, the Company requires precertification/preapproval through AIM Specialty Health® (AIM) for the following services:
Facility-based sleep disorder testing and positive airway pressure (PAP) titration
Positive airway pressure therapy
Supplies related to PAP therapy
To direct the application of these services for our members, AIM utilizes Medicare coverage guidance (eg, Local Coverage Determinations [LCD], National Coverage Determinations [NCD]). If no Medicare coverage guidance exists, AIM utilizes their Sleep Disorder Management Diagnostic & Treatment Guidelines.
For more information about the services and devices that require precertification/preapproval, refer to current version of medical policy #MA07.058: Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies.
AIM’s medical necessity guidelines are consistent with the clinical appropriateness criteria based on technology assessment, peer-reviewed medical literature including clinical outcomes research and consensus opinion in medical practice. To access the complete list of AIM Specialty Health Sleep Disorder Management Diagnostic & Treatment Guidelines, click
Issued on - 07/17/2020
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