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November 2018

Scoring hypopnea in adults: Which standard is acceptable?

What’s hypopnea?

Hypopnea, a partial blockage of the airway, is a feature of a condition called obstructive sleep apnea hypopnea syndrome. Hypopnea is a type of sleep apnea. It’s characterized by slow or shallow breathing while apnea means periods of no breathing.

There’s been some confusion among health care providers about what criteria Blue Cross Blue Shield of Michigan will accept for diagnostic purposes when scoring hypopnea in adults.

There are two standards used in scoring hypopnea. The American Academy of Sleep Medicine** recommends a 3 percent or greater oxygen desaturation from the pre-event baseline or the event associated with an arousal, while the Centers for Medicare & Medicaid Services requires a 4 percent or greater oxygen desaturation.

Keep in mind that Blue Cross will accept either standard when scoring hypopnea.

To read more about Blue Cross’ sleep apnea policy, see the policy titled Continuing Coverage of CPAP Machines and Supplies for the Treatment of Obstructive Sleep Apnea. To access our medical policies, follow these steps:

  • From the web-DENIS homepage, click on BCBSM Provider Publications and Resources.
  • To search for a policy by procedure code, click on Benefit policy for a code.
  • If you don’t have the code, click on Medical Policy and Precert/Pre-Auth Router.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.