By 2025-10-30: Billing team must update system rules to enforce Aetna's pediatric OSA coverage criteria. REQUIREMENTS: (1) Update CPT code 95808, 95810, 95811, 95782, 95783 processing to require documentation of one of the eight covered diagnostic indications (OSAS differentiation, hypersomnia, narcolepsy screening, parasomnia, restless leg syndrome, PLMD, central alveolar hypoventilation, or sleep-related hypoventilation); (2) For post-operative polysomnography (codes 95808, 95810, 95811, 95782, 95783), require 6-8 week post-op delay documentation and one of nine clinical factors (age <3, cardiac complications, craniofacial anomalies, failure to thrive, neuromuscular disorders, obesity, prematurity, recent respiratory infection, severe pre-op OSAS with RDI ≥19, or persistent symptoms); (3) Flag CPT 42975 (drug-induced sleep endoscopy) claims to verify: persistent OSA documented by prior sleep study, failure of non-invasive therapy, surgical candidacy, and age 0-18; (4) DENY all claims for experimental/investigational codes including mandibular distraction (use ortho/sleep medicine consultation), maxillary expanders, oral appliances in healthy children, laser-assisted uvuloplasty, injection snoreplasty, montelukast, nasal surgery, abbreviated PSG/home PSG, and respiratory muscle therapy; (5) Permit hypoglossal nerve stimulation (Inspire system) ONLY for adolescents 13-18 with Down syndrome, AHI 10-50, no concentric soft palate collapse, adenotonsillectomy contraindication/failure, PAP therapy failure despite compliance efforts, and documented consideration of alternatives; (6) Update prior authorization workflow to capture these criteria on encounter forms; (7) Audit recent claims for codes 76120-76125 (pre-operative echocardiography) and deny if for pre-operative tissue doppler assessment in OSA surgery cases. Notify providers in writing of experimental/investigational denials. Failure to implement will result in medical necessity denials and provider compliance issues.