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

Coverage for surgical treatment of obstructive sleep apnea is governed by the medical necessity and coverage criteria in LCD L34526. Several palatal and tongue-base procedures — including LAUP, Somnoplasty™, palatal implants (Pillar Procedure™), and submucosal tongue-base radiofrequency (CPT 41530) — are not covered (denied as not proven effective or investigational); billing guidance requires use of unlisted codes (CPT 42299 or hospital C9727) with the procedure name in the electronic narrative for denial processing.

"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."

Sign up to see full coverage criteria, indications, and limitations.