Gelardi et al (2007) assessed variations of pharyngometric parameters in patients with sleep disorders and established a correlation between morpho-volumetric variations of oro-pharyngo-laryngeal spaces and the presence and severity of disease. In a study to ascertain whether the Eccovision reflectance pharyngometer could assess the anatomical structure of the upper airway in young children, Hatzakis et al (2003) found that the Eccovision pharyngometer does not reliably assess pharyngeal volumes in a pediatric population. This device is marketed as a screening method to quickly assess a patient for potential sites of sleep-related upper airway obstruction, and to better determine whether an oral appliance or continuous positive airway pressure is more appropriate for the patient. Computer processing of the incident and reflected sound waves from the airways provides an area distance curve representing the lumen from which minimal cross-sectional area and volume can be derived. The Eccovision™ Acoustic Reflection Pharyngometer (Hood Laboratories, Pembroke, MA) provides a non-invasive assessment of the dimensions, structure and physiological behavior of the upper airway from the oral cavity to the hypopharnyx while the patient breathes. Multiple methods that detect structural and functional abnormalities of the upper airway implicated as risk factors for obstructive sleep apnea (OSA) continue to stimulate interest because it is hoped that they may allow physicians to more easily distinguish patients with OSA from those without it, and therefore reduce the number of unnecessary sleep studies. Insomnia and hypersomnia not due to a substance or known physiological condition ICD-10 codes covered if selection criteria are met: Home sleep test (HST) with type IV portable monitor, unattended minimum of 3 channels HCPCS codes covered if selection criteria are met: SNAP Testing system using 3 or more channels: Other sleep disorders not due to a substance or known physiological condition ![]() ICD-10 codes not covered for indications listed in the CPB (not all-inclusive): Codes requiring a 7th character are represented by "+": ![]() Information in the below has been added for clarification purposes. Table: CPT Codes / HCPCS Codes / ICD-10 Codes Code This Clinical Policy Bulletin addresses acoustic pharyngometers and SNAP testing system.Īetna considers SNAP Testing using 3 or more channels a medically necessary device for home diagnosis of OSA in adults, according to the criteria in CPB 0004 - Obstructive Sleep Apnea in Adults.Īetna considers acoustic pharyngometry (e.g., Eccovision Acoustic Pharyngometer), and versions of the SNAP Testing System using fewer than 3 channels, experimental and investigational for screening, diagnosis, treatment planning, or prediction of surgical success in persons with suspected or known obstructive sleep apnea (OSA) and for all other indications because their effectiveness has not been established. ![]() Number: 0336 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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