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UnitedHealthcareMedicaid · Coverage · Medical Policy · PA · ENT (Ear, Nose & Throat), Sleep Medicine, PulmonologyHigh impact

Obstructive and Central Sleep Apnea Treatment (for Pennsylvania Only)

Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
Oct 3, 2026

Summary

UnitedHealthcare Community Plan of Pennsylvania updated its Obstructive and Central Sleep Apnea treatment policy effective November 1, 2026. The revision adds radiofrequency ablation of the soft palate and/or tongue base to the list of unproven and not medically necessary procedures, updates clinical evidence references, and clarifies coverage criteria for surgical and non-surgical treatments. Billing teams must immediately identify and deny claims for this newly excluded procedure.

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What to do

by Oct 31, 2026 · 6 steps
01Billing team must update billing system and claims processing software to deny all claims for radiofrequency ablation of the soft palate and/or tongue base (regardless of CPT code used) for Pennsylvania Medicaid members.
02Add this procedure to the excluded/non-covered list for UnitedHealthcare Community Plan of Pennsylvania.
03Update provider communications and pre-authorization templates to reflect that this procedure is no longer covered.
04Train billing staff to identify claims for this procedure and issue denials with reference to the October 2026 policy update.
05Providers must be notified immediately to prevent submission of claims for this procedure.
06Implement denial reason codes in billing system noting 'not medically necessary per UHC PA Community Plan policy effective 11/01/2026.'

Original notice

Obstructive and Central Sleep Apnea Treatment (for Pennsylvania Only)
uhcprovider.com · Always check the source before changing claims.
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Related changes

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UnitedHealthcare policiesPA policy changesENT (Ear, Nose & Throat)Sleep MedicinePulmonology

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