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Obstructive Sleep Apnea in Children (CPB 0752, reviewed 2025-10-30)
Aetna·Effective Oct 30, 2025
Aetna's updated pediatric obstructive sleep apnea policy (CPB 0752, effective 2025-10-30) establishes comprehensive medical necessity criteria for diagnosis and treatment modalities in children under 18. Key coverage includes nocturnal polysomnography for diagnosis, adenotonsillectomy as first-line treatment, CPAP when surgery is contraindicated/delayed/unsuccessful, and hypoglossal nerve stimulation for adolescents with Down syndrome meeting specific criteria. Multiple procedures including mandibular distraction, maxillary expansion, and various laser/injection techniques are classified as experimental/investigational and not covered.