Surgical treatments for obstructive sleep apnea (Orthognathic surgery, other surgical treatments, radiofrequency submucosal ablation)
Defines Medicare Advantage coverage guidance and applicable procedure/diagnosis codes for orthognathic surgery, other surgical treatments, and radiofrequency submucosal ablation for obstructive sleep apnea (OSA), and instructs compliance with applicable LCDs/LCAs or internal criteria (InterQual) where no LCD/LCA exists.
Revised language pertaining to coverage guidelines for states/territories with no LCDs/LCAs; replaced reference to 'InterQual CP: Procedures, Maxillomandibular Advancement' with 'InterQual CP: Procedures, Orthognathic Surgery'.
Coverage Summary
Defines Medicare Advantage coverage guidance and applicable procedure and diagnosis codes for orthognathic surgery, other surgical treatments, and radiofrequency submucosal ablation for obstructive sleep apnea (OSA). Coverage is determined by applicable Medicare NCDs/LCDs/LCAs where they exist, and where no local Medicare determination exists for the state/territory, coverage is determined using InterQual/internal criteria referenced in the policy. The listing of CPT codes in this policy is provided for reference only and does not imply coverage or guarantee reimbursement.
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