Obstructive and Central Sleep Apnea Treatment – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers removable oral appliances for OSA, selected surgeries (UPPP, mandibular osteotomy, maxillomandibular advancement) and FDA‑approved hypoglossal nerve stimulation for strictly selected patients, while listing many non‑surgical devices (positional devices, nasal dilators, EPAP, prefabricated appliances, intraoral electrical stimulation, palatal implants, RFA alone, TORS, DOME, isolated uvulectomy/hyoid myotomy, lingual suspension, implantable CSA neurostimulation, etc.) and those surgical approaches as unproven and not medically necessary. Coverage requires attended polysomnography (surgical indications generally AHI/RDI ≥15), face‑to‑face diagnosis by a qualified sleep physician (or supervised APP), documented PAP failure/intolerance/refusal, device‑specific FDA criteria (e.g., HNS: adult BMI ≤40, AHI 15–100, <25% central/mixed apneas and absence of complete concentric palatal collapse on DISE), and additional documentation per InterQual and policy‑specific requirements (including pediatric Down syndrome HNS criteria where applicable).