Obstructive and Central Sleep Apnea Treatment (for Ohio Only)
Clinical coverage and medical necessity criteria for non‑surgical and surgical treatments of obstructive and central sleep apnea for members in Ohio; governs providers and claims subject to Ohio Administrative Code and UnitedHealthcare policies.
Added language to indicate implantable hypoglossal nerve stimulation is medically necessary in certain circumstances for members 22 years of age and older; for medical necessity clinical coverage criteria, refer to InterQual® CP: Procedures Hypoglossal Nerve Stimulation (HNS).
Replaced prior language to extend medical necessity determination for implantable hypoglossal nerve stimulation to members 18 to 21 years of age when all listed criteria are met.
Added notation to indicate polysomnography should be repeated if there has been clinically significant weight change, changes in cardiovascular disease, or persistent/recurrent symptoms since the last study.
Revised coverage criterion language about absence of complete concentric collapse at the soft palate confirmed by drug-induced sleep endoscopy (wording changed).
Added CPT/HCPCS codes 0964T, 0965T, 0966T, and E0490 to applicable codes.
Updated FDA and References sections to reflect the most current information.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.