Does C9727 require prior authorization?

Yes, C9727 requires prior authorization (high confidence). Code explicitly requires prior authorization.

`C9727`, Insertion of implants into the soft palate; minimum of three implants

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

If LAUP, Somnoplasty™, Pillar Procedure™/palatal implant, or other non-covered palatal procedures are billed for denial purposes, bill as CPT 42299 (unlisted procedure, palate/uvula) and include the procedure name (e.g., 'LAUP', 'Somnoplasty', 'Pillar Procedure', 'palatal implant') in the electronic narrative field 2400/SV101-7 (CMS-1500 line 19 equivalent).
Hospital outpatient departments should use HCPCS code C9727 for palatal implant procedures (Pillar Procedure™) when billing; such claims will be denied as not proven effective.
Billing and coding determinations for surgical OSA treatment are dependent on meeting LCD L34526 medical necessity and coverage documentation requirements.
For BIPAP/related devices coverage for nocturnal hypoventilation/restrictive thoracic disorders: documentation of qualifying diagnosis codes (G47.34, G47.36, G70.*, J40-J44, M95.4, Q67.8) and clinical documentation that CPAP is intolerant or ineffective

Surgical treatment of obstructive sleep apnea (OSA) is considered for coverage only when it meets the coverage indications, limitations, and medical necessity requirements described in LCD L34526.
Continuous Positive Airway Pressure (CPAP) devices and accessories — HCPCS E0601 and listed masks/interfaces/accessories (A7027–A7046, A7037–A7039, E0561–E0562, etc.) covered for obstructive sleep apnea (G47.33) when selection criteria are met (AHI thresholds specified).
CPAP coverage with AHI ≥15 for OSA (G47.33) — CPAP is covered when selection criteria (AHI ≥15) are met.
CPAP coverage with AHI 5–14 for OSA when specified comorbid conditions (see list above) or excessive sleepiness criteria are present — CPAP covered when selection criteria met.
AutoPAP/APAP and pressure-relief technologies (e.g., C-Flex) — covered under applicable HCPCS when selection criteria for CPAP/APAP are met.
Bi-level PAP and respiratory assist devices (E0470, E0472) — covered for OSA members intolerant of CPAP or when CPAP/AutoPAP is ineffective; covered for diagnoses with nocturnal hypoventilation (G47.34, G47.36) and for restrictive thoracic and chronic lower respiratory disease diagnoses (G70.*, J40–J44, M95.4, Q67.8) when selection criteria are met.

A56905, Billing and Coding: Surgical Treatment of Obstructive Sleep Apnea (OSA)

WPS-L34526, Surgical Treatment of Obstructive Sleep Apnea (OSA)

AETNA-CPB-0752, Obstructive Sleep Apnea in Children

BCBSIL-SUR706.009, Sleep Related Breathing Disorders: Surgical Management

BCBSMT-SUR706.009, Sleep Related Breathing Disorders: Surgical Management

Ask Verity about documentation requirements, denial risks, or coverage in your state.