MedicaidCoverageMedium impact
Obstructive Sleep Apnea Interventional Therapy - MEDICAID - SOUTH CAROLINA (New)
Humana·SC · ENT (Ear, Nose & Throat), Sleep Medicine, General Surgery·Medicaid
Effective date
May 25, 2026
We identified it
Jun 24, 2026
Summary
New South Carolina Medicaid policy establishes that uvulectomy (CPT 42140) is NOT covered for treatment of obstructive sleep apnea and is considered not medically necessary. This policy creates a clear coverage exclusion for this procedure when billed for OSA treatment.
Action Required
Before May 25, 2026: Billing team must update system to flag CPT 42140 (uvulectomy) as non-covered for South Carolina Medicaid when diagnosed with obstructive sleep apnea. Train staff to verify alternative covered treatments for OSA patients. Claims for this procedure/diagnosis combination will be denied.