Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

FDA‑approved hypoglossal nerve stimulation is covered for adults age 22 and older with moderate to severe obstructive sleep apnea (AHI 15–65) who have BMI <35, predominantly obstructive events (central+mixed <25%), a PSG within 24 months, documented CPAP failure or intolerance, absence of complete concentric collapse on DISE, and no anatomic findings that would compromise device performance. Coverage is excluded for non‑FDA devices, significant cardiopulmonary or neurological comorbidities (e.g., BMI ≥35, hypoglossal-nerve palsy, severe pulmonary disease, recent MI, NYHA III/IV), pregnancy, certain MRI requirements, inability to operate the remote, and other listed contraindications; required documentation includes PSG, DISE, CPAP usage records, shared decision making, and provider/manufacturer training certifications.

"Beneficiary is 22 years of age or older."