Billing and Coding: Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

This billing and coding guidance permits billing for HNS implantation, revision/replacement, and removal for obstructive sleep apnea when LCD L38276 coverage criteria are met, using the specified CPT codes. Claims must include valid ICD-10 diagnosis codes, required documentation (symptoms, polysomnography, DISE CPT 42975, BMI, history/physical), and appropriate ABN handling and modifiers; replacements/revisions are only considered necessary if the original implantation met LCD criteria.

"New implantation of a hypoglossal nerve stimulator (HNS) for treatment of obstructive sleep apnea (OSA) is covered when the patient meets the Local Coverage Determination L38276 coverage criteria."

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