Maintenance of Wakefulness Testing
Maintenance of wakefulness testing (MWT) is a covered benefit for inappropriate sleep episodes, amnesiac episodes or continuous agonizing drowsiness. For active duty service members (ADSMs) with obstructive sleep apnea (OSA), MWT is a limited benefit.
Active duty service members require an approval from Health Net Federal Services, LLC and the following must be met to be considered for coverage:
- The referral specifies the ADSM has been diagnosed with OSA and the nearest military hospital or clinic cannot accommodate the request.
- The ADSM has received at least 30 days of described treatment (for example, continuous positive airway pressure [PAP]).
- The sleep facility is American Academy of Sleep Medicine (AASM)-certified.
- The ADSM’s actual PAP usage compared to Service-specific compliance requirements shows patient adherence.
Active duty service members treated with surgical therapy must have a documented post-operative polysomnography confirming an apnea hypopnea index (AHI) of less than five per hour. These results should be included with the authorization request.
Civilian providers: If the PAP usage compliance requirements and other criteria listed above are not met, the MWT will not be covered. Please report this information and assessment of MWT appropriateness to the referring provider through the clear and legible report process.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.