Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

FDA‑approved hypoglossal nerve stimulation is covered for adults (age ≥22) with moderate-to-severe obstructive sleep apnea (AHI 15–65) who have BMI <35, predominantly obstructive events (central/mixed apneas <25% of AHI), a PSG within 24 months, documented CPAP failure or intolerance with shared decision making, and absence of complete concentric collapse on DISE without other anatomical contraindications (e.g., large tonsils). Coverage is denied for non‑FDA devices, patients meeting listed contraindications (for example BMI ≥35, neuromuscular disease, hypoglossal palsy, significant cardiac or pulmonary disease, pregnancy, inability to operate the remote), and when manufacturer MRI restrictions or device interactions apply. Providers must document PSG, CPAP failure/intolerance and SDM, DISE findings and manufacturer certification for DISE review, and clinician training/competency; records must be retained for possible post‑payment review.

"Beneficiary is 22 years of age or older."