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Surgical Management of Sleep Disorders 7.01.41
Effective date
Jan 22, 2026
Identified
Jun 20, 2026
Summary
Policy 7.01.41, Surgical Management of Sleep Disorders, is effective January 22, 2026. It states that hypoglossal nerve upper airway stimulation is medically appropriate for moderate-to-severe obstructive sleep apnea (OSA) when all listed criteria are met for each age group, and that hypoglossal nerve or upper airway treatment of OSA that does not meet those criteria is investigational. The 01/22/26 revision made the stimulation statement applicable to any device and added the investigational statement, and a 10/22/26 code edit added C8007 and C8011 with policy intent unchanged.
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What to do
Action · 5 steps
01Already effective January 22, 2026: Billing team, before billing upper airway stimulation for adults over 18, document an AHI of 15 to 100 events per hour, central and mixed apneas of 25% or less, failure or inability to use CPAP (a residual AHI of 15 or higher, or failure to use CPAP at least 4 hours per night for at least 5 nights per week), all previous treatment measures and why they were unsuccessful, no complete concentric collapse of the soft palate, and a BMI under 40.
02Upper airway stimulation is contraindicated when the individual is pregnant or plans to become pregnant.
03Septoplasty, turbinate reduction, polypectomy, and radiofrequency ablation or somnoplasty of palatal tissues are not medically necessary for OSA.
04For device repair, physician documentation must include the date of implantation or initiation, manufacturer warranty information if applicable, and an attestation that the individual has been compliant with the device and will continue to benefit from it.
05Repair of equipment damaged by neglect, theft, or abuse, or when another available coverage source is an option, is ineligible for coverage.
Codes mentioned
21244305203062031600415124153042145428204282164568645826458364584959709597695977C1823C8007C8011C9727S2080F51.8G47.00G47.10G47.20G47.69
Original notice
Surgical Management of Sleep Disorders 7.01.41
excellusbcbs.com · Always check the source before changing claims.
Related changes
See all Excellus BlueCross BlueShield changes →Medical Management Obstructive Sleep Apnea (OSA) 1.01.07MediumEffective Oct 22, 2026 · Lungs (Respiratory)Medical Management Obstructive Sleep Apnea (OSA) 1.01.07MediumEffective Oct 22, 2026 · Lungs (Respiratory)Vagus Nerve Stimulation and Vagus Nerve Blocking Therapy 7.01.05MediumEffective Aug 20, 2026 · Nervous Systems (Neurology)Sleep Studies 2.01.28MediumEffective Jan 22, 2026 · Sleep MedicineBrowse every Excellus BlueCross BlueShield change in the policy list
Related policy hubs
Excellus BlueCross BlueShield policiesENT (Ear, Nose & Throat)Sleep MedicineCode 21244Code 30520Code 30620Code 31600Code 41512Code 41530Code 42145Code 42820Code 42821Code 64568Code 64582Code 64583Code 64584Code 95970Code 95976Code 95977Code C1823Code C8007Code C8011Code C9727Code S2080Code F51.8Code G47.00Code G47.10Code G47.20Code G47.69