CommercialCoverageMedium impact
Medical Policy Update for January 24, 2023
Blue Cross NC·NC · Sleep Medicine, Pulmonology·Medical Policy
Effective date
Jan 24, 2023
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated their sleep apnea diagnosis and management policy to expand coverage for oral appliances as an alternative to CPAP therapy. The policy now covers oral appliances when patients are not CPAP candidates, have failed CPAP despite compliance programs, or prefer oral appliances as initial therapy.
Action Required
Immediately: Update prior authorization and billing procedures for sleep apnea oral appliance claims. Ensure documentation includes one of the new qualifying criteria: patient not a CPAP candidate, CPAP ineffective after 45-day trial with compliance program, patient non-compliant with CPAP after 45-day trial with compliance program, or patient preference for oral appliance as initial therapy. Update encounter forms and EMR templates to capture these requirements.