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 here.

    Issued on - 07/17/2020

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