CommercialCoverageHigh impact
Sleep Studies 2.01.28
Excellus BlueCross BlueShield·Sleep Medicine, Pulmonology, Neurology +1 more·Sleep Medicine
Effective date
Jan 22, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their sleep studies policy (2.01.28) effective January 22, 2026, establishing comprehensive medical necessity criteria for polysomnography, CPAP titration, MSLT testing, and other sleep disorder diagnostics. The policy defines specific conditions and circumstances when facility-based sleep studies are considered medically appropriate versus not covered.
Action Required
By January 22, 2026: Billing team must review all sleep study orders against the new medical necessity criteria in policy 2.01.28. Update prior authorization processes to verify patients meet specific conditions listed in sections I-VIII before scheduling facility-based polysomnography, CPAP titration, or MSLT testing. Train providers on documentation requirements for the 24 high-risk scenarios and contraindications to home sleep testing. Claims not meeting these criteria will be denied.