Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

This policy covers implantation of the Inspire® hypoglossal (upper airway) stimulation system for treatment of moderate-to-severe obstructive sleep apnea (OSA) in patients who have failed or are intolerant of positive airway pressure (CPAP/BPAP). Coverage is limited to patients meeting objective criteria—typically age ≥22 (with limited adolescent/Down syndrome exceptions), AHI usually 15–100 (some subgroups 15–50), BMI generally ≤40 kg/m² (often ≤32 kg/m² for certain criteria), a qualifying polysomnogram within 24 months, documented PAP failure/intolerance and appropriate upper-airway evaluation—and excludes non‑Inspire devices, patients with exclusionary anatomy (e.g., complete concentric palatal collapse), pregnancy, incompatible implants or MRI requirements beyond device labeling.

"Moderate to severe obstructive sleep apnea (OSA) in patients who have failed continuous positive airway pressure (CPAP)."