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Obstructive and Central Sleep Apnea Treatment (for Tennessee Only)
Effective date
Dec 1, 2026
Identified
Nov 7, 2026
Summary
UnitedHealthcare Community Plan of Tennessee revised its Medicaid medical policy on obstructive and central sleep apnea treatment, effective 2026-12-01. Revised coverage adds radiofrequency ablation of the soft palate and/or tongue base to the list of unproven and not medically necessary surgical procedures, and adds HCPCS code L8697 to the applicable codes list. Removable oral appliances require documentation that PAP therapy failed or was not tolerated, and the policy defines the diagnosis requirements before treatment begins.
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What to do
Action · 3 steps
01By 2026-12-01: Billing team should update charge entry and claim edits for Tennessee Community Plan Medicaid members so that L8697 is recognized as an applicable code.
02Providers and front desk staff should be told that radiofrequency ablation of the soft palate and/or tongue base is now listed as unproven and not medically necessary for this plan, and that oral appliance claims need documentation from the treating physician or Advanced Practice Provider showing PAP therapy failed, was ineffective, or was not tolerated, along with a sleep study.
03Claims without this documentation will be denied under the policy, so attach or improve documentation in the chart before submission.
Codes mentioned
L8697
Original notice
Obstructive and Central Sleep Apnea Treatment (for Tennessee Only)
uhcprovider.com · Always check the source before changing claims.
Related changes
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