Home cardiorespiratory monitoring may be considered medically necessary when initiated in infants younger than 12 months of age in the following situations (see Policy Guidelines):
Those with tracheostomies or anatomic abnormalities that make them vulnerable to airway compromise; OR
Those with neurologic or metabolic disorders affecting respiratory control, including central apnea and apnea of prematurity; OR
Those with chronic lung disease (ie, bronchopulmonary dysplasia; see Policy Guidelines).
Home cardiorespiratory monitoring is considered investigational when used as a strategy to reduce the risk of Sudden Infant Death Syndrome (SIDS).
Home cardiorespiratory monitoring is considered investigational when used for cardiopulmonary evaluation in lower-risk infants following a brief resolved unexplained event (BRUE), which was previously known as an apparent life threatening event (ALTE) (see Policy Guidelines for further discussion of BRUE risk).
Home cardiorespiratory monitoring in all other conditions, including but not limited to, the diagnosis of obstructive sleep apnea, is considered investigational.
