Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

FDA‑approved hypoglossal nerve stimulation is covered for adults aged ≥22 with BMI <35, AHI 15–65, predominantly obstructive events (central+mixed <25%), a PSG within 24 months, documented CPAP failure or intolerance with shared decision making, and absence of complete concentric collapse on DISE and no anatomical contraindications (e.g., large tonsils). Coverage is denied for non‑FDA devices, when listed medical or device contraindications exist (including BMI ≥35, neuromuscular disease, significant cardiopulmonary disease, recent major cardiac events, pregnancy, inability to operate the remote, or >25% central/mixed apneas), and requires specific documentation of PSG, DISE, CPAP history, provider training, and DISE validation per manufacturer guidance.

"Beneficiary is 22 years of age or older."

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