Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

FDA‑approved hypoglossal nerve stimulation is covered for selected adults (age ≥22) with moderate‑to‑severe OSA (AHI 15–65) who have BMI <35, predominantly obstructive events (<25% central/mixed), documented CPAP failure or intolerance, absence of complete concentric collapse on DISE, and no anatomic findings that would impair device function. Coverage requires supporting documentation including a recent PSG (within 24 months), DISE findings, shared decision‑making notes, CPAP usage evidence, and documented provider/manufacturer training; multiple specific medical and device contraindications (e.g., BMI ≥35, neuromuscular disease, certain cardiac/pulmonary conditions, pregnancy, MRI restrictions) render the procedure not reasonable and necessary.

"Beneficiary is age 22 years or older."

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