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UnitedHealthcareExchange · Coverage · Medical Policy · Sleep Medicine, ENT (Ear, Nose & Throat), Pulmonology +1 moreHigh impact

Obstructive and Central Sleep Apnea Treatment

Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
Sep 2, 2026

Summary

UnitedHealthcare revised its sleep apnea treatment policy effective November 1, 2026, adding radiofrequency ablation of the soft palate and/or tongue base to the list of unproven and not medically necessary procedures for obstructive sleep apnea. This means claims for radiofrequency ablation procedures will be denied for OSA treatment. The policy also updated clinical evidence sections and clarified coverage for oral appliances, surgical procedures, and hypoglossal nerve stimulation.

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What to do

by Oct 31, 2026 · 4 steps
01Billing team must update claim submission and denial protocols to reflect that radiofrequency ablation of the soft palate and/or tongue base (CPT 42257, 42258, or similar radiofrequency codes applied to soft palate/tongue base) for obstructive sleep apnea treatment is now non-covered.
02Providers must update surgical consent forms and care plans to document that radiofrequency ablation is not covered by UnitedHealthcare Exchange plans.
03Update clinical staff and coding personnel that this procedure should not be billed to UnitedHealthcare Exchange for OSA treatment.
04Flag all pending claims for radiofrequency ablation procedures to determine if they qualify under the previous policy version; claims submitted on or after November 1, 2026 will be denied as not medically necessary.

Original notice

Obstructive and Central Sleep Apnea Treatment
uhcprovider.com · Always check the source before changing claims.
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Related changes

See all UnitedHealthcare changes →
Obstructive and Central Sleep Apnea Treatment (for Pennsylvania Only)HighEffective Nov 1, 2026 · Medical PolicyObstructive and Central Sleep Apnea Treatment (for New Mexico Only)MediumEffective Nov 1, 2026 · Medical PolicyObstructive and Central Sleep Apnea Treatment (for New Jersey Only)MediumEffective Nov 1, 2026 · Medical PolicyObstructive and Central Sleep Apnea Treatment (for Nebraska Only)MediumEffective Nov 1, 2026 · Medical PolicyBrowse every UnitedHealthcare change in the policy list

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UnitedHealthcare policiesSleep MedicineENT (Ear, Nose & Throat)PulmonologyGeneral Surgery

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