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Independence Blue CrossCommercial · Billing Codes · Medical Policy · Sleep Medicine, Neurosurgery, ENT (Ear, Nose & Throat) +2 moreMedium impact

11.00.06w, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring

Act
by Jul 22, 2026
Effective date
Jan 1, 2026
Identified
Jul 23, 2026

Summary

Independence Blue Cross reissued policy 11.00.06w on treatment of obstructive sleep apnea and primary snoring with no substantive changes to coverage criteria. Six new HCPCS codes (C8007, C8008, C8009, C8011, C8012, C8013) for hypoglossal nerve neurostimulator procedures were added as medically necessary, effective retroactively to January 1, 2026. A new coverage criterion was added for hypoglossal nerve stimulation in pediatric patients (ages 13-18) with OSA and Down syndrome.

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What to do

by Jul 22, 2026 · 6 steps
01Billing team must update billing system and claim submission processes to recognize HCPCS codes C8007, C8008, C8009, C8011, C8012, and C8013 as medically necessary for hypoglossal nerve neurostimulator implantation, revision, and removal procedures for OSA patients.
02Ensure ICD-10 code G47.33 is linked to these procedures.
03For pediatric patients ages 13-18, verify diagnosis coding includes G47.33 (OSA) AND at least one Down syndrome code (Q90.0, Q90.1, Q90.2, or Q90.9) to establish medical necessity.
04Update prior authorization workflows if applicable.
05Claims submitted with these codes prior to 01/01/2026 should be reprocessed retroactively if previously denied.
06Train billing staff and providers on new coverage criteria for pediatric hypoglossal nerve stimulation.

Codes mentioned

C8007C8008C8009C8011C8012C8013G47.33Q90.0Q90.1Q90.2Q90.9

Original notice

11.00.06w, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
11.00.06w, Treatment of Obstructive Sleep Apnea (OSA) and Primary SnoringMediumEffective Jan 1, 2026 · Medical Policy11.00.06u, Treatment of Obstructive Sleep Apnea (OSA) and Primary SnoringMediumEffective Feb 17, 2025 · Medical Policy11.00.06v, Treatment of Obstructive Sleep Apnea (OSA) and Primary SnoringMediumEffective Jul 1, 2025 · Medical Policy11.00.06v, Treatment of Obstructive Sleep Apnea (OSA) and Primary SnoringMediumEffective Jul 1, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesSleep MedicineNeurosurgeryENT (Ear, Nose & Throat)Oral & Maxillofacial SurgeryPediatricsCode C8007Code C8008Code C8009Code C8011Code C8012Code C8013Code G47.33Code Q90.0Code Q90.1Code Q90.2Code Q90.9

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