CommercialBilling CodesMedium impact
11.00.06v, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring
Independence Blue Cross·PA · Sleep Medicine, Dentistry, Oral & Maxillofacial Surgery +2 more·Medical Policy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has added three new CPT codes (0964T, 0965T, 0966T) for custom jaw expansion oral prostheses for obstructive sleep apnea treatment, effective July 1, 2025. These codes are designated as medically necessary when criteria for OSA diagnosis and treatment are met. The policy also reissued version 11.00.06w on October 29, 2025 to communicate the company's continuing position on OSA and primary snoring treatment.
Action Required
By July 1, 2025: Billing team must update billing software and fee schedules to recognize and process CPT codes 0964T (single arch jaw expansion prosthesis), 0965T (dual arch with mandibular advancement, non-fixed hinge), and 0966T (dual arch with mandibular advancement, fixed hinge) as medically necessary for obstructive sleep apnea treatment. Update claim submission rules to automatically include diagnosis code G47.33 with these codes. Add medical necessity validation: claims require documentation of certified sleep study with AHI/RDI ≥15 events/hour (minimum 30 events), OR AHI/RDI 5-14 events/hour with comorbidities, OR AHI/RDI >30 with CPAP intolerance/contraindication. Providers must document sleep study results and CPAP trial/intolerance on all claims. Billing staff should flag claims missing sleep study documentation for denial. Update superbill templates and encounter forms to include these new codes as options for OSA treatment authorization.