CommercialBilling CodesMedium impact
11.00.06w, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring
Independence Blue Cross·Sleep Medicine, Pulmonology, ENT (Ear, Nose & Throat) +3 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued Policy 11.00.06w for treatment of obstructive sleep apnea and primary snoring with no substantive changes to coverage criteria. However, six new HCPCS codes (C8007, C8008, C8009, C8011, C8012, C8013) for hypoglossal nerve neurostimulator procedures have been added as medically necessary, effective retroactively to January 1, 2026. Additionally, hypoglossal nerve stimulation is now covered for pediatric patients ages 13-18 with OSA and Down syndrome.
Action Required
By April 1, 2026: Billing team must update billing system to recognize and process the six new hypoglossal nerve neurostimulator HCPCS codes (C8007, C8008, C8009, C8011, C8012, C8013) as medically necessary under IBC commercial plans, retroactive to January 1, 2026. Update prior authorization templates and fee schedules in billing software. Additionally, configure system to allow coverage of hypoglossal nerve stimulation for pediatric patients ages 13-18 when diagnosis codes G47.33 (OSA) are combined with Q90.0, Q90.1, Q90.2, or Q90.9 (Down syndrome variants). Providers should be notified that claims with these codes and Down syndrome diagnoses submitted for pediatric patients will now be processed for payment. Ensure any claims previously denied with these codes and pediatric OSA/Down syndrome diagnoses are reviewed for reprocessing with retroactive application.