CommercialAdministrativeMedium impact
07.03.05ac, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
Independence Blue Cross·Sleep Medicine, Pulmonology, Internal Medicine·Medical Policy
Effective date
Sep 19, 2026
We identified it
Aug 22, 2026
Summary
Independence Blue Cross has updated policy 07.03.05ac effective 09/19/2026 to delegate sleep disorder testing and PAP therapy utilization management to Carelon Medical Benefits Management. Six procedure codes (CPT 95800, 95801, 95806 and HCPCS G0398, G0399, G0400) have been removed from the policy. Minor narrative revisions were made to HCPCS codes A7032 and A7046 regarding replacement supply descriptions.
Action Required
By September 19, 2026: (1) Billing team must update billing system to remove CPT codes 95800, 95801, 95806 and HCPCS codes G0398, G0399, G0400 from this policy's covered code list for Independence Blue Cross commercial plans. (2) Update system narratives for HCPCS A7032 to reflect 'Cushion for use on nasal mask interface, replacement only, each' and A7046 to reflect 'Water chamber for humidifier, used with positive airway pressure device, replacement, each'. (3) Ensure all sleep disorder testing and PAP therapy claims are now routed to Carelon Medical Benefits Management for utilization management review (except emergency room or inpatient/observation unit services). (4) Verify that all claims include current standard written orders signed and dated by treating provider, plus proof of delivery documentation, per policy requirements. Failure to comply will result in claim denials and payment recoupment.