Common Reasons For Apnea Monitors

Most Insurance companies considers apnea monitors medically necessary durable medical equipment (DME) for infants less than 12 months of age with documented apnea or who have known risk factors for life threatening apnea according to the following indications:

  • Infants with apnea of prematurity, defined as sudden cessation of breathing that lasts for at least 20 seconds or is accompanied by bradycardia (heart rate less than 80 beats per minute) or oxygen desaturation (O2 saturation less than 90 % or cyanosis) in an infant younger than 37 weeks’ gestational age. Continued use is considered medically necessary until they are past a post-conceptional age of 43 weeks and are event free for 6 weeks.
  • Infants with an apparent life-threatening event (ALTE), defined as an episode that is characterized by some combination of apnea (central or occasionally obstructive), color change (usually cyanotic or pallid but occasionally erythematous or plethoric), marked change in muscle tone (usually marked limpness), choking, or gagging. If monitored due to ALTE, use of an apnea monitor is considered medically necessary until the baby remains event free for 6 weeks.
  • Infants with bradycardia on caffeine, theophylline, or similar agents, until event free for 6 weeks off medication.
  • Diagnosis of pertussis, with positive cultures, upon discharge from acute care facility. If monitored for pertussis, use of an apnea monitor is considered medically necessary for up to 1 month post diagnosis.
  • Documented gastroesophageal reflux disease (GERD) that results in apnea, bradycardia, or oxygen de-saturation, until the infant remains event free for 6 weeks.
  • Infants with tracheostomies or anatomic abnormalities that make them vulnerable to airway compromise (medical necessity reviewed on an individual case basis).
  • Infants with neurologic or metabolic disorders affecting respiratory control (medical necessity reviewed on an individual case basis).
  • Infants with chronic lung disease (bronchopulmonary dysplasia), especially those requiring supplemental oxygen, continuous positive airway pressure, or mechanical ventilation.
  • Documented prolonged apnea of greater than 20 seconds in duration; use of an apnea monitor is considered medically necessary until the infant remains event free for 6 weeks.
  • Documented apnea accompanied by bradycardia to less than 80 beats per minute; use of an apnea monitor is considered medically necessary until the infant remains event free for 6 weeks.
  • Documented apnea accompanied by oxygen desaturation (oxygen saturation below 90 %), cyanosis or pallor; use of an apnea monitor is considered medically necessary until the infant remains event free for 6 weeks.
  • Documented apnea accompanied by marked hypotonia; use of an apnea monitor is considered medically necessary until the infant remains event free for 6 weeks.
  • Later siblings of infants who died of sudden infant death syndrome (SIDS), use of an apnea monitor is considered medically necessary until the later siblings are 1 month older than the age at which the earlier sibling died and they remain event free.

There are three types of infant apnea: central, obstructive, and mixed central and obstructive apnea. In central or diaphragmatic apnea, the infant makes no effort to breathe; the chest is still, and no air passes through the mouth or nose. In obstructive apnea, the chest is moving but no air passes through the mouth or nose (usually due to soft tissue such as the tongue blocking the upper airway). In mixed apnea, the infant has episodes of both central and obstructive apnea all within the same event. Most home infant apnea monitors measure chest movements and heart rate. Normally, the monitor’s alarm is set to go off if the infant stops breathing for 20 seconds or if the heart rate slows to less than 80 beats per minute.

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Contact

NBN Infusions
2 Pin Oak Lane, Suite 250
Cherry Hill NJ 08003
Phone: 856-669-0217
Fax: 856-424-8913