Medicare AdvantageBilling CodesMedium impact
MA05.047o, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults
Independence Blue Cross·Sleep Medicine, Pulmonology, Dentistry +1 more·Medical Policy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage updated policy MA05.047o for treatment of OSA and primary snoring in adults, adding three new CPT codes (0964T, 0965T, 0966T) for custom jaw expansion oral prostheses effective 07/01/2025. The policy was reissued on 10/29/2025 to communicate the Company's continuing position. Billing teams must recognize these new codes as medically necessary when criteria are met and update systems accordingly.
Action Required
By 07/01/2025: Billing team must update billing software and encoder systems to recognize CPT codes 0964T, 0965T, and 0966T as medically necessary for Medicare Advantage plans when documented with appropriate ICD-10 diagnosis codes (G47.33 for OSA or R06.83 for primary snoring). Ensure prior authorization workflows reflect coverage criteria: certified sleep study with AHI/RDI documentation, in-person clinical evaluation by treating provider, and documentation that patient is intolerant of or has contraindications to CPAP/bi-level devices. Train billing staff and providers on medical necessity criteria for these new oral prosthesis codes. Update claim scrubbing rules to prevent denials for appropriately documented cases. Flag claims lacking required sleep study documentation or provider clinical evaluation for denial.