CommercialDocumentationMedium impact
07.03.05ab, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
Independence Blue Cross·Sleep Medicine, Pulmonology·Medical Policy
Effective date
Nov 15, 2025
We identified it
Jun 19, 2026
Summary
Policy 07.03.05ab has been updated effective 11/15/2025 with changes to medical necessity criteria and general guidelines for sleep disorder testing and positive airway pressure (PAP) therapy services and supplies. The billing team must review the updated medical necessity requirements and adjust prior authorization, documentation, and billing processes accordingly.
Action Required
By 11/15/2025: Billing team must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=11&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-07-03-05ab to identify specific medical necessity criteria changes. Update prior authorization requirements, encounter forms, and provider documentation templates to reflect new guidelines for sleep disorder testing and PAP therapy. Communicate updated requirements to providers and front desk staff. Failure to implement new medical necessity criteria may result in claim denials for non-compliant submissions.