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 updated OSA/snoring policy 11.00.06v to version 11.00.06w, adding three new CPT codes (0964T, 0965T, 0966T) for custom jaw expansion oral prostheses effective July 1, 2025. These codes are now covered as medically necessary when criteria are met. The policy maintains existing coverage requirements for oral appliances, mandibular advancement devices, and hypoglossal nerve stimulation.
Action Required
By July 1, 2025: Billing team must update billing system to recognize and process CPT codes 0964T, 0965T, and 0966T as medically necessary covered services for OSA treatment. Add these codes to fee schedules and update claim submission rules. Ensure prior authorization workflows align with existing oral appliance requirements (certified sleep study diagnosis with specified AHI/RDI thresholds). Providers performing jaw expansion oral prosthesis procedures must document sleep study results and meet medical necessity criteria per policy. Update encounter templates to capture required diagnostic documentation. Verify claims with these new codes are not denied due to unrecognized procedure codes. Communicate changes to dental and sleep medicine providers submitting these claims.