Surgical Treatments for Obstructive Sleep Apnea - (0158)

Cigna covers DISE in specified adult, adolescent and pediatric scenarios, uvulopalatopharyngoplasty (UPPP), multi‑level surgery, maxillomandibular advancement, and FDA‑approved implantable hypoglossal nerve stimulation when documentation shows PAP treatment failure (inability to eliminate OSA, typically AHI >15), PAP intolerance (inability to achieve ≥4 hours/night on ≥5 nights/week) or unwillingness to use PAP, plus required objective findings (AHI/BMI limits, DISE findings such as absence of complete concentric palatal collapse, prior MRA/other therapies considered, and age/craniofacial criteria). Procedures to treat snoring alone and listed interventions (e.g., uvulectomy as a stand‑alone, CAPSO, Pillar implants, RFVTR, tongue‑base suspension/implants, atrial overdrive pacing, transpalatal advancement, off‑the‑shelf hypoglossal remote batteries, etc.) are considered experimental, investigational, or not medically necessary.

"Drug-induced sleep endoscopy (DISE) is considered medically necessary for the evaluation of upper airway surgery in an adult when EITHER of the following is met: persistent obstructive sleep apnea ..."