← Back to list
Obstructive Sleep Apnea and Other Sleep Related Breathing Disorder Treatments - Medicare Advantage (Revised)
Effective date
Nov 2, 2026
Identified
Nov 3, 2026
Summary
Humana Medicare Advantage updated its sleep apnea treatment policy effective 11/02/2026, revising coverage criteria for surgical and nonsurgical OSA treatments. The policy now explicitly lists services that are not medically necessary, including nonsurgical neuromuscular electrical stimulation (eXciteOSA system), Genio System implants, tongue-based suspension surgery, and standalone uvulectomy. Billing teams must stop billing these noncovered services for affected members and ensure claims for covered surgical procedures include proper clinical documentation meeting the cited LCD criteria.
Get alerts when payers change rules like this one
We check Humana and other payers every day and email you when a change matches your specialty and state.
Get Humana alertsPolicy Monitoring is free. No card required.
What to do
Action · 7 steps
01Effective 11/02/2026, for Humana Medicare Advantage members in jurisdictions J6/JK, J15, JE/JF, JH/JL, JJ/JM, and JN (those without a local LCD).
02Billing team must stop billing E0490, E0491, E0492, E0493 (nonsurgical neuromuscular electrical stimulation including eXciteOSA), CPT 64568 when used for Genio System implants, CPT 41512 (tongue-based suspension surgery), and CPT 42140 (uvulectomy as standalone OSA treatment) — claims for these services will be denied as not medically necessary.
03For covered surgical procedures (genioglossal advancement 21685/21199, mandibular maxillary osteotomy 21110/21141/21145/21196/21199, and UPPP 42145/42950), update charge entry to ensure claims include documentation that the member has moderate-to-severe OSA, has failed first-line therapies (PAP, oral appliances, behavioral modification), and meets clinical criteria in LCD L34526.
04Obtain prior authorization before scheduling these covered surgical procedures, as the policy references applicable LCD requirements.
05Tell providers and front desk staff that noncovered services listed above cannot be scheduled for Humana MA members in these jurisdictions.
06For members who may still request noncovered services, advise patients in writing of noncoverage status per the member's coverage document.
07For jurisdictions with their own LCD (J5, J8 covering IA, KS, MO, NE, IN, MI), continue following the applicable MAC LCD L34526.
Codes mentioned
21110211412114521196211992168541512415304214042145422994295064568E0490E0491E0492E0493C1778C9727
Original notice
Obstructive Sleep Apnea and Other Sleep Related Breathing Disorder Treatments - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Obstructive Sleep Apnea and Other Sleep Related Breathing Disorders Surgical Treatments - Medicare Advantage (Revised)MediumEffective Jun 1, 2026 · Medicare AdvantageOrthognathic Surgery - Medicare Advantage (Revised)MediumEffective Feb 2, 2026 · Medicare AdvantageObstructive Sleep Apnea Interventional Therapy - MEDICAID - MICHIGAN (New)MediumEffective May 22, 2026 · MedicaidObstructive Sleep Apnea Interventional Therapy - MEDICAID - ILLINOIS (New)MediumEffective May 22, 2026 · MedicaidBrowse every Humana change in the policy list