Obstructive and Central Sleep Apnea Treatment (for Indiana Only)

Before December 1, 2026: Billing team must update coding system to reflect quarterly HCPCS edits and add L8697 to the applicable codes list for sleep apnea devices. Immediately implement denial logic in billing software to reject claims for radiofrequency ablation of soft palate and/or tongue base as non-covered procedures. Providers must update prior authorization templates to require attending polysomnography documentation, BMI verification, and AHI/RDI values for all surgical procedures (UPPP, orthognathic surgery, hypoglossal nerve stimulation). For hypoglossal nerve stimulation claims on members aged 10-21, billing team must verify age-specific criteria in charts (Down syndrome diagnosis for ages 10-18; BMI and AHI thresholds for all ages) before submission. Update encounter forms and EMR templates to capture required clinical evidence including Epworth Sleepiness Scale scores, PAP therapy failure documentation, and drug-induced sleep endoscopy results. Train front desk and clinical staff on new coverage restrictions for prefabricated oral appliances, positional devices, nasal dilators, and electrical muscular training—these should now be denied as unproven. Failure to implement these changes will result in increased claim denials for Indiana Medicaid members.