Skip to main content

Medical Policy Revision: Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome

Effective May 1, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome.

Access our Medical Policy Manual to review this medical policy content.¹


Claims submitted for services provided on and after May 1, 2019 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO), or Medicare Advantage (MA) plans will be processed as follows.

  • Regardless of the submitted diagnosis code(s), CPT® codes 0466T, 0467T or 0468T will be denied, as experimental/investigational non-covered services.
  • Based on the submitted diagnosis code(s), CPT codes 41512 and/or 41530 may be denied as experimental/investigational, non-covered services.
  • Based on the submitted diagnosis code(s), CPT codes 21685, 41512, 41530 or 42145 included on claims for services provided to patients age 18 years and older may be denied as not related to the submitted diagnosis code(s).

Claims submitted for services provided on and after May 1, 2019 to patients enrolled in Horizon BCBSNJ commercial or ASO plans will be processed as follows based on the submitted diagnosis code(s).

  • HCPCS code S2080 submitted on claims for patients age 18 years and older may be denied, as not related to the submitted diagnosis code(s).
  • HCPCS code S2080 submitted on claims for patients of any age may be denied as experimental/investigational, non-covered services.

Claims submitted for services provided on and after May 1, 2019 to patients enrolled in Horizon BCBSNJ MA plans will be processed as follows.

  • Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT codes 21198, 21199 or 21206.

    Following our review, the services represented by these codes may be denied as not medically necessary or as not related to the submitted diagnosis code(s).

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after May 1, 2019.

CPT® is a registered mark of the American Medical Association.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

Published on: January 30, 2019, 15:35 p.m. ET
Last updated on: January 31, 2019, 01:26 a.m. ET