Maintenance of Wakefulness Tests for Active Duty Service Members
Friday, June 7, 2019
TRICARE recently developed a new set of benefit coverage guidelines for active duty service members (ADSMs) diagnosed with obstructive sleep apnea to get a Maintenance of Wakefulness Test (MWT) to determine treatment effectiveness for those with ongoing sleepiness issues.
Prior authorization is required and the following criteria must be met in order for coverage to apply:
- The ADSM must have been diagnosed with obstructive sleep apnea and have already received at least 30 days of treatment (for example, Continuous Positive Airway Pressure [CPAP]).
- If the ADSM has received Positive Airway Pressure (PAP) therapy, the referring provider must indicate the PAP usage (hours used and a percentage of nights since the therapy began) and how that usage compares to Service-specific compliance requirements on the authorization request.
- The MWT must be performed by a sleep facility certified by the American Academy of Sleep Medicine.
- For ADSMs treated with surgical therapy, an MWT can only be performed if they had a post-operative polysomnography confirming an apnea hypopnea index of less than five per hour.
Health Net Federal Services, LLC offers an MWT Letter of Attestation that can be submitted in lieu of clinical documentation with your authorization request.
Please visit our Maintenance of Wakefulness Testing page for detailed benefit information.