CommercialCoverageMedium impact
Medical Management Obstructive Sleep Apnea (OSA) 1.01.07
Excellus BlueCross BlueShield·Sleep Medicine, Pulmonology, Dentistry +1 more·Lungs (Respiratory)
Effective date
Feb 16, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their policy for oral appliance therapy (OAT) for obstructive sleep apnea, defining specific severity criteria and coverage requirements. The policy specifies when oral appliances are medically appropriate based on AHI/RDI scores and establishes that prefabricated devices are not covered, only custom appliances.
Action Required
By February 16, 2026: Billing team must update prior authorization processes for oral appliance therapy to include AHI/RDI severity documentation (mild: 5-14, moderate: 15-29, severe: ≥30) and evidence of CPAP intolerance or contraindication. Stop billing for prefabricated oral appliances as they are not covered. Update encounter forms to require sleep study documentation and collaboration with sleep specialists for all oral appliance requests.