Surgical Treatment of Obstructive Sleep Apnea (OSA)
L34526
Surgical treatments for OSA are covered selectively: UPPP is covered for patients with RDI >=15, documented retropalatal or combined obstruction, prior CPAP failure or intolerance, diagnosis from an AASM-recognized certified sleep lab, and documented counseling by a sleep-trained physician. Mandibular Maxillary Osteotomy (± genioglossus advancement/hyoid suspension) is covered for RDI >=15 with retrolingual obstruction or prior UPPP failure under the same diagnostic and counseling requirements; tracheostomy and surgeries correcting discrete anatomic contributors are covered when medically necessary and other treatments have failed or are ineffective. Several procedures (LAUP, Somnoplasty™, Pillar palatal implants, and submucosal RF ablation of the tongue base) are explicitly not covered or are considered investigational.
"Uvulopalatopharyngoplasty (UPPP) is covered when all of the following are met: OSA diagnosed in a certified sleep disorders laboratory, Respiratory Disturbance Index (RDI) >= 15, failed or cannot t..."