Medicare AdvantageCoverageMedium impact
Obstructive Sleep Apnea and Other Sleep Related Breathing Disorders Surgical Treatments - Medicare Advantage (Revised)
Humana·IA, KS, MO, NE, IN, MI · ENT (Ear, Nose & Throat), Oral & Maxillofacial Surgery, Sleep Medicine +1 more·Medicare Advantage
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated coverage criteria for obstructive sleep apnea surgical treatments, establishing specific medical necessity requirements for procedures like uvulopalatopharyngoplasty and genioglossal advancement, while excluding coverage for certain procedures like tongue-based suspension surgery and uvulectomy as standalone OSA treatment.
Action Required
Before June 1, 2026: Billing team must update prior authorization protocols for OSA surgical procedures to align with LCD L34526 criteria. Update billing system to flag non-covered procedures (64568, 41512, 42140 as standalone OSA treatment) for Humana Medicare Advantage claims. Train providers on new medical necessity documentation requirements for covered procedures (21685, 21199, 21110, 21141, 21145, 21196, 42145, 42950). Claims not meeting LCD criteria will be denied as not medically necessary.