Obstructive and Central Sleep Apnea Treatment (for Kentucky Only)
Medical policy governing non-surgical and surgical treatments for obstructive and central sleep apnea for UnitedHealthcare members in Kentucky, including coverage stance and criteria for devices, oral appliances, surgeries, and implantable neurostimulation.
Revised list of unproven and not medically necessary items/devices and added 'advanced lightweight functional appliances (ALF)' to that list.
For implantable hypoglossal nerve stimulation in adults with FDA-approved devices, added requirement that PAP therapy resulted in no therapeutic efficacy or patient refusal or intolerance.
Removed requirement for failure of adequate trial of CPAP therapy and failure of adequate trial of oral appliance therapy for adult implantable hypoglossal nerve stimulation.
Changed required AHI threshold for implantable hypoglossal nerve stimulation in adults from ≥20 to ≥15 (AHI by attended polysomnography) while retaining upper limit ≤100.
For adolescents (ages 10–18) with Down syndrome receiving implantable hypoglossal nerve stimulation, added requirement for confirmed failure or intolerance of PAP despite attempts to improve compliance and removed prior documentation requirement for CPAP refusal.
Updated notation clarifying dental services (D9947, D9948, D9949) are generally excluded from coverage under the medical plan.
Updated supporting sections: Description of Services, Clinical Evidence, FDA, and References to reflect current information.
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