CommercialCoverageMedium impact
Positive Airway Pressure Devices CPAP BiPAP APAP and Noninvasive Positive Pressure Ventilators (NIV) 1.01.06
Excellus BlueCross BlueShield·Sleep Medicine, Pulmonology·Sleep Medicine
Effective date
Jul 17, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their positive airway pressure device policy effective July 17, 2025, establishing specific criteria for CPAP, BiPAP, and APAP coverage including AHI/RDI thresholds, 90-day trial periods, and compliance requirements. The policy details when devices are medically necessary for OSA, central sleep apnea, and chronic respiratory failure with specific documentation requirements.
Action Required
By July 17, 2025: Sleep medicine and pulmonology billing teams must update prior authorization requests to include specific AHI/RDI values, document 90-day trial periods, and track compliance metrics (70% of nights, 4+ hours per night for 30 consecutive days) for CPAP/BiPAP continuation coverage. Update encounter forms to capture required sleep study results and symptom documentation. Failure to meet these criteria will result in claim denials.