Apnea Monitor Rental Information
Below is an example of insurance coverage requirements from Highmark for a Home Apnea Monitor. Call Vantage today at 877-593-6328 for assistance with your insurance coverage.
The rental of a home cardiorespiratory monitor may be considered medically necessary for the following infants:
- Those less than 12 months of age, when the observer reports a brief resolved unexplained event with ANY of the following symptoms: (an episode of some combination of apnea, color change, marked change in muscle tone, choking/gagging, altered level of responsiveness); or
- Those with tracheostomies or anatomic abnormalities that make them vulnerable to airway compromise; or
- Those with neurologic or metabolic disorders affecting respiratory control; or
- Those with chronic lung disease (e.g., bronchopulmonary dysplasia), particularly those requiring supplemental oxygen, continuous positive airway pressure, or mechanical ventilation; or
- Those with apnea of prematurity, defined as sudden cessation of breathing that lasts for at least twenty (20) seconds or is accompanied by bradycardia (heart rate less than 80 beats per minute) or oxygen (O2) desaturation (O2 saturation less than 90% or cyanosis) in an infant with early home discharge prior to term (38 weeks). Continued use is considered medically necessary up to 43 weeks postmenstrual age or event free for two (2) weeks, whichever comes later.
Home cardiorespiratory monitoring is considered not medically necessary in infants with any siblings with a history of sudden infant death syndrome (SIDS), but without AT LEAST ONE (1) of the indications cited.
Home cardiorespiratory monitoring in all other conditions is considered experimental/investigational and, therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
The following services provided in conjunction with the monitor are non-covered:
- A back-up battery, electrical system, or any alteration to the living quarters required for the monitor.
- Parental training sessions, including cardiopulmonary resuscitation or instruction in use of the monitor.
- Any charges for standby medical, technical, or counseling assistance.
Procedure Codes
E0618 E0619 E1399
Infant monitoring may only be billed once per 30-day period of time, services that exceed that amount will be denied as not medically necessary.
Procedure Codes
94774 94775 94776 94777