MedicaidCoverageMedium impact
Obstructive and Central Sleep Apnea Treatment (for Ohio Only)
UnitedHealthcare·OH · Sleep Medicine, ENT (Ear, Nose & Throat), Oral & Maxillofacial Surgery +1 more·Medical Policy
Effective date
Nov 1, 2026
We identified it
Oct 3, 2026
Summary
UnitedHealthcare Community Plan of Ohio (Medicaid) 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 surgical procedures. Billing teams must deny claims for this procedure and ensure providers understand it is no longer covered. Dental procedure codes (D9947, D9948, D9949) are clarified as excluded from medical plan coverage.
Action Required
By October 15, 2026: Billing team must update claim adjudication rules to deny radiofrequency ablation of soft palate and/or tongue base (procedure code not specified in policy but typically CPT 42615 or similar) as not medically necessary for Ohio Medicaid members. Update billing system edits and denial templates to reference this policy revision. Notify ENT/sleep medicine providers of the coverage change via bulletin or update to provider portal. Ensure all staff processing Ohio Medicaid claims under UnitedHealthcare Community Plan understand that dental appliance codes D9947, D9948, and D9949 are excluded from medical plan coverage and should be referred to dental plans. Claims submitted on or after November 1, 2026 without prior authorization denial will result in improper payment.