Clinical UM Guideline
Subject: Nasal Surgery for the Treatment of Obstructive Sleep Apnea and Snoring
Guideline #: CG-SURG-87 Publish Date: 07/06/2022
Status: Reviewed Last Review Date: 05/12/2022
Description

This document addresses nasal surgery for the treatment of obstructive sleep apnea (OSA) and snoring

Note: Please see the following related documents for additional information:

Clinical Indications

Not Medically Necessary:

Nasal surgery employing any technique is considered not medically necessary for the treatment of snoring.

Nasal surgery employing any technique, including nasal valve surgery, septoplasty, turbinectomy, polypectomy and laser or radiofrequency ablation (volumetric tissue reduction) of the nasal turbinates is considered not medically necessary for the treatment of obstructive sleep apnea and other sleep related breathing disorders.

Coding

The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services are Not Medically Necessary:
For the following procedure and diagnosis codes; or when the code describes a procedure designated in the Clinical Indications section as not medically necessary.

CPT

 

30110

Excision, nasal polyp(s), simple

30115

Excision, nasal polyp(s), extensive

30130

Excision inferior turbinate, partial or complete, any method

30140

Submucous resection inferior turbinate, partial or complete, any method

30465

Repair of nasal vestibular stenosis (e.g., spreader grafting, lateral nasal wall reconstruction)

30468

Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)

30520

Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft

30801

Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (e.g., electrocautery, radiofrequency ablation, or tissue volume reduction); superficial

30802

Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (e.g., electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (i.e., submucosal)

31237

Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)

 

 

ICD-10 Procedure

 

095K0ZZ-095KXZZ

Destruction of nose [by approach; includes codes 095K0ZZ, 095K3ZZ, 095K4ZZ, 095KXZZ]

095L0ZZ-095L8ZZ

Destruction of nasal turbinate [by approach; includes codes 095L0ZZ, 095L3ZZ, 095L4ZZ, 095L7ZZ, 095L8ZZ]

09BK0ZZ-09BKXZZ

Excision of nose [by approach; includes codes 09BK0ZZ, 09BK3ZZ, 09BK4ZZ, 09BKXZZ]

09BL0ZZ-09BL8ZZ

Excision of nasal turbinate [by approach; includes codes 09BL0ZZ, 09BL3ZZ, 09BL4ZZ, 09BL7ZZ, 09BL8ZZ]

09BM0ZZ-09BM4ZZ

Excision of nasal septum [by approach; includes codes 09BM0ZZ, 09BM3ZZ, 09BM4ZZ]

09DL0ZZ-09DL8ZZ

Extraction of nasal turbinate [by approach; includes codes 09DL0ZZ, 09DL3ZZ, 09DL4ZZ, 09DL7ZZ, 09DL8ZZ]

09TL0ZZ-09TL8ZZ

Resection of nasal turbinate [by approach; includes codes 09TL0ZZ, 09TL4ZZ, 09TL7ZZ, 09TL8ZZ]

09TM0ZZ-09TM4ZZ

Resection of nasal septum [by approach; includes codes 09TM0ZZ, 09TM4ZZ]

 

 

ICD-10 Diagnosis

 

G47.30-G47.39

Sleep apnea

G47.8

Other sleep disorders

G47.9

Sleep disorder, unspecified

R06.83

Snoring

Discussion/General Information

It has been postulated that increased nasal resistance may contribute to, or be causative in, sleep related breathing disorders, such as obstructive sleep apnea (OSA). Nasal procedures that have been performed for the treatment of OSA include the following:

Studies suggest stimulation of receptors in the nasal airway improves muscle tone in the oropharynx, and increased nasal resistance results in increased negative intraluminal pressure, causing an increased tendency for the soft tissues of the upper airway (soft palate and pharyngeal walls) to collapse. In addition, nasal obstruction may lead to mouth breathing and mouth opening which, in turn, results in inferior movement of the mandible with associated decrease in pharyngeal diameter. The base of the tongue may also fall backwards reducing the posterior pharyngeal space. The rationale for nasal surgery is to improve nasal patency re-establishing physiological breathing and minimizing oral breathing during sleep; also to reduce nasal resistance and improve the negative intraluminal pressure which generates upper airway collapse.

However, studies have not demonstrated that reducing nasal obstruction and resistance from various causes and using various techniques, (for example, septoplasty, turbinectomy, polypectomy, radiofrequency volumetric tissue reduction [RFVTR] of inferior nasal turbinates) correlates with a significant reduction in objective indicators for OSA, such as the Apnea-Hypopnea Index (AHI) or nocturnal oxygen desaturation. Although some studies have suggested that surgical correction of nasal obstruction may improve subjective complaints in individuals with OSA, in general, they have been flawed by a relatively limited number of participants, the fact that nasal surgery is often performed in association with other surgical procedures, and lack of objective data regarding nasal resistance and OSA diagnostic variables.

Kim and colleagues (2021) published the results of a prospective, nonrandomized study evaluating the subjective and objective outcomes in individuals with OSA after nasal surgery alone. The study involved 35 individuals with symptomatic nasal obstruction for > 3 months, nasal septal deviation with inferior turbinate hypertrophy determined by endoscopic examination, history of habitual snoring, and an AHI score of > 5 events per hour. Individuals were excluded from participation if they were > 65 years of age, had morbid obesity (body mass index > 35 kg/m2), gross maxillary deformities, macroglossia, suspected oropharyngeal or hypopharyngeal narrowing during sleep endoscopy, or were undergoing simultaneous oropharyngeal or hypopharyngeal surgery. Participants underwent septoplasty with volume reduction of the bilateral inferior turbinates using a microdebrider. Outcome measures included subjective improvement in nasal obstruction and OSA-related symptoms using a Visual Analogue Scale (VAS) and the Epworth Sleepiness Scale (ESS) to evaluate daytime sleepiness. Objective measures were based on polysomnographic findings. Successful nasal surgery was defined as a postoperative AHI score of < 20 times per hour and a reduction of ≥ 50%. Postoperative evaluations occurred 6 months after the surgical procedure. The average VAS score decreased significantly from 7.4 ± 1.5 to 1.4 ± 1.1 (p<0.001). The mean snoring score (evaluated using the VAS) significantly improved from 7.5 ± 1.5 to 4.9 ± 1.8 (p<0.001). The mean ESS score significantly decreased from 7.9 ± 4.9 to 5.3 ± 3.8 (p<0.001). Polysomnography findings showed a statistically significant reduction in mean AHI from 28.5 ± 22.3 to 18.5 ± 19.8 (p<0.001) and mean respiratory disturbance index from 32.3 ± 20.1 to 21.1 ± 17.7 (p<0.001). However, there were no statistically significant differences in either non-supine AHI or snoring between before and after nasal surgery (p=0.298 and p=0.199, respectively). There was no significant difference in mean oxygen saturation between preoperative and postoperative results (p=0.056). Only 5 participants (14.3%) met the success criteria. Participants with allergic rhinitis had a significantly better success rate compared to those without (50% compared to 3.8%, respectively; p=0.026) and those with moderate or severe nasal obstruction (based on Nasal Obstruction Symptom Evaluation scale) had a significantly better success rate compared to those with mild obstruction (p=0.033). The results suggest that the presence of allergic rhinitis and the severity of nasal obstruction may assist in identifying individuals who may benefit from isolated nasal surgery for the treatment of OSA. However, the overall success rate was low and this study had several significant limitations including a small sample size, lack of a control group, and short follow-up duration.

In a Cochrane review, Rimmer and colleagues (2014) found:

The evidence relating to the effectiveness of different types of surgery versus medical treatment for adults with chronic rhinosinusitis with nasal polyps is of very low quality. The evidence does not show that one treatment is better than another in terms of patient-reported symptom scores and quality of life measurements. The one positive finding from amongst the several studies examining a number of different comparisons must be treated with appropriate caution, in particular when the clinical significance of the measure is uncertain. As the overall evidence is of very low quality (serious methodological limitations, reporting bias, indirectness and imprecision) and insufficient to draw firm conclusions, further research to investigate this problem, which has significant implications for quality of life and healthcare service usage, is justified.

In June 2016, the LateraAbsorbable Nasal Implant (Spirox Inc., Menlo Park, CA) was cleared by the FDA for “Supporting nasal upper and lower lateral cartilage.” This implantable device is proposed to assist in the surgical correction of collapsed nasal wall tissue, possibly improving nasal obstruction. The implant consists of copolymer materials and is designed to be absorbed by the body within approximately 18 months following implantation. The Latera system also includes a disposable delivery device that enables minimally invasive placement of the implant. The Latera implant and accessory delivery device have the same fundamental scientific technology and intended indications for use as the predicate device, the INEX Absorbable Nasal Implant and accessory delivery tool that received FDA 510(k) clearance on December 4, 2015 (K152958). Studies have been limited by small numbers of participants, lack of randomization, short term outcomes data and study design not robust enough to demonstrate the safety and efficacy of this implant for any indication (San Nicoló, 2017, 2018; Stolovitzky, 2018). There remains a lack of evidence directly evaluating the impact of this implant on OSA.

In their June 2003 review article, Chen and Kushida concluded that, “The exact role obstructed nasal breathing plays in the pathogenesis of OSA type sleep disorders remains presumptive, and robust clinical studies to evaluate the contribution of nasal function remain elusive. More stringently controlled studies are needed.” Another review by Rappai concluded that, “To date, there are no compelling data to demonstrate causality between nasal obstruction and persistent sleep disordered breathing.” They point out that most of the studies reviewed in their 2003 review article are short term, or only examined subjective outcomes to evaluate the effect on sleep disordered breathing. The authors concluded that further studies are needed to prove specific causality. There continues to be a lack of large, well-designed clinical trials sufficiently powered to support the safety and efficacy of nasal surgical procedures for OSA.

Another proposed use of nasal surgical procedures is to improve compliance with continuous positive airway pressure (CPAP) use in individuals with OSA and nasal obstruction requiring high CPAP settings. CPAP intolerance has been investigated in small retrospective studies with some favorable evidence showing reduced postoperative CPAP titration levels by at least 1 cm water. However, variable additional factors also impact CPAP compliance, such as individual perception of symptoms and improvement in sleepiness and daily function from initial use of CPAP. For these reasons, larger, well-designed studies are needed to confirm the durability of any beneficial effect on CPAP compliance from nasal surgical procedures for individuals with OSA (Friedman, 2009; Masdon, 2004; Weaver, 2008; Zonato, 2006).

In a review, Bury and colleague (2015) found that snoring and obstructive sleep apnea have been well researched. While the studies supporting nasal surgery for snoring can improve the quality of life, it may not lead to the resolution of snoring. Likewise, compliance with nasal treatments for OSA may increase the quality of life in some individuals. Further well-designed studies are needed to clarify the role of nasal surgery in OSA, with stratification of individuals who may benefit from nasal intervention.

The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) has published several position statements on nasal surgery as it applies to OSA. In a position statement on the surgical management of obstructive sleep apnea (2014), the AAO-HNS included surgical procedures involving the nose in a list of procedures they consider effective and not investigational when they are part of a comprehensive approach in the medical and surgical management of individuals with OSA. The AAO-HNS also published a position statement on nasal surgery and OSA (2017) in which they stated, “nasal surgery is a beneficial modality for the treatment of obstructive sleep apnea.” In a position statement on the treatment of obstructive sleep apnea (2021), the AAO-HNS included this statement:

Nasal surgery, such as septoplasty, turbinate surgery, and procedures aimed to address nasal valve collapse, is a beneficial adjunct in the treatment of adult OSA. Nasal surgery results in improvement in daytime sleepiness and sleep quality. While the impact of nasal surgery on the AHI is often only modest, these procedures may result in a significant decrease in respiratory distress index. Nasal surgery offers the additional benefit of improving CPAP compliance.

The AAO-HNS has also published an expert consensus statement addressing septoplasty with or without inferior turbinate reduction (2015). Using a modified Delphi method, expert opinion from a panel of specialists was distilled into clinical statements that met the standardized definition of consensus. Based on an anonymous survey response, the panel reached consensus stating that:

Septoplasty can improve continuous positive air pressure tolerance for patients with sleep apnea and a deviated septum.

The American Academy of Sleep Medicine (AASM) published a clinical practice guideline on the referral of adults with obstructive sleep apnea for surgical consultation (2021). The document included the following conditional recommendations:

Recommendation 3:
We suggest that clinicians discuss referral to a sleep surgeon with adults with OSA, BMI < 40 kg/m2 , and persistent inadequate PAP adherence due to pressure-related side effects as part of a patient-oriented discussion of adjunctive or alternative treatment options (CONDITIONAL).

Recommendation 4:
We suggest that clinicians recommend PAP as initial therapy for adults with OSA and a major upper airway anatomic abnormality prior to consideration of referral for upper airway surgery (CONDITIONAL).

The third recommendation is followed by an explanation that a surgical referral may be informed by the presence of surgically treatable conditions that can contribute to upper airway obstruction such as persistent nasal obstruction.

While there is a growing body of evidence on nasal procedures that have the potential to impact OSA and snoring, evidence in the form of well-designed, randomized studies that clearly define appropriate criteria for individuals with OSA who would derive a net health benefit from these procedures is lacking.

Definitions

Chronic: Refers to persistent conditions with symptoms that last over a long period of time.

Delphi Method: A structured communication technique or method originally developed as a systematic, interactive forecasting method which relies on a panel of experts. The experts answer questionnaires in two or more rounds.

Nasal turbinates: The scroll-like bony plates with curved margins on the lateral wall of the nasal cavity.

Sleep apnea: Temporary stoppage of breathing during sleep, which can result in excessive daytime sleepiness.

Snoring: A fluttering sound created by the turbulent airflow vibrations of upper airway soft tissue during sleep.

Somnoplasty® (also referred to as radiofrequency ablation [RFA] or radiofrequency volumetric tissue reduction [RFVTR]): These terms refer to a minimally invasive surgical procedure that reduces the excess volume of the surrounding tissues in the upper airway, in order to enlarge the space. These procedures have been purported to reduce the symptoms of OSA and snoring. Although the procedure has been used to remove tissue from the turbinates and tonsils, recent studies of RFA in the treatment of OSA have limited the procedure to the soft palate, uvula and tongue base. The Somnoplasty® System (Somnus Medical Technologies, Sunnyvale, CA) received clearance from the U.S. Food and Drug Administration (FDA) on July 17, 1997 for coagulation of soft tissue, including the uvula/soft palate. The 510(k) summary states that, “The Somnoplasty system may reduce the severity of snoring in some individuals.” An expanded approval on November 2, 1998 states that, “The system is intended for the reduction of the incidence of airway obstruction in patients with upper airway resistance syndrome and OSA.”

References

Peer Reviewed Publications:

  1. Bäck LJ, Hytonen ML, Roine RP, Malmivaara AV. Radiofrequency ablation treatment of soft palate for patients with snoring: a systematic review of effectiveness and adverse effects. Laryngoscope. 2009; 119(6):1241-1250.
  2. Bican A, Kahraman A, Bora I, et al. What is the efficacy of nasal surgery in patients with obstructive sleep apnea syndrome? J Craniofac Surg. 2010; 21(6):1801-1806.
  3. Blumen MB, Chalumeau F, Gauthier A, et al. Comparative study of four radiofrequency generators for the treatment of snoring. Otolaryngol Head Neck Surg. 2008; 138(3):294-299.
  4. Bury SB1, Singh A. The role of nasal treatments in snoring and obstructive sleep apnea. Curr Opin Otolaryngol Head Neck Surg. 2015; 23(1):39-46.
  5. Cavaliere M, Mottola G, Iemma M. Monopolar and bipolar radiofrequency thermal ablation of inferior turbinates: 20-month follow-up. Otolaryngol Head Neck Surg. 2007; 137(2):256-263.
  6. Ceylan K, Emir H, Kizilkaya Z, et al. First-choice treatment in mild to moderate obstructive sleep apnea: single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction or nasal continuous positive airway pressure. Arch Otolaryngol Head Neck Surg. 2009; 135(9):915-919.
  7. Chen W, Kushida, CA. Nasal obstruction in sleep disordered breathing. Otolaryngol Clin North Am. 2003; 36(3):437-460.
  8. Choi JH, Kim EJ, Kim YS, et al. Effectiveness of nasal surgery alone on sleep quality, architecture, position, and sleep-disordered breathing in obstructive sleep apnea syndrome with nasal obstruction. Am J Rhinol Allergy. 2011; 25(5):338-341.
  9. Franklin KA, Anttila H, Axelsson S, et al. Effects and side-effects of surgery for snoring and obstructive sleep apnea—a systematic review. Sleep. 2009; 32(1):27-36.
  10. Friedman M, Lin HC, Gurpinar B, Joseph NJ. Minimally invasive single-stage multilevel treatment for obstructive sleep apnea/hypopnea syndrome. Laryngoscope. 2007; 117(10):1859-1863.
  11. Friedman M, Soans R, Joseph N, et al. The effect of multilevel upper airway surgery on continuous positive airway pressure therapy in obstructive sleep apnea/hypopnea syndrome. Laryngoscope. 2009; 119(1):193-196.
  12. Gindros G, Kantas I, Balatsouras DG, et al. Comparison of ultrasound turbinate reduction, radiofrequency tissue ablation and submucosal cauterization in inferior turbinate hypertrophy. Eur Arch Otorhinolaryngol. 2010; 267(11):1727-1733.
  13. Harrill WC, Pillsbury HC, McGuirt WF, Stewart MG. Radiofrequency turbinate reduction: a NOSE evaluation. Laryngoscope. 2007; 117(11):1912-1919.
  14. Hytonen ML, Bäck LJ, Malmivaara AO, Roine RP. Radiofrequency thermal ablation for patients with nasal symptoms: a systematic review of effectiveness and complications. Eur Arch Otorhinolaryngol. 2009; 266(8):1257-1266.
  15. Kim SD, Jung DW, Lee JW, et al. Relationship between allergic rhinitis and nasal surgery success in patients with obstructive sleep apnea. Am J Otolaryngol. 2021; 42(6):103079.
  16. Kizilkaya Z, Ceylan K, Emir H, et al. Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy. Otolaryngol Head Neck Surg. 2008; 138(2):176-181.
  17. Koutsourelakis I, Georgoulopoulos G, Perraki E, et al. Randomized trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnea. Eur Respir J. 2008; 31(1):110-117.
  18. Li HY, Lin Y, Chen NH, et al. Improvement in quality of life after nasal surgery alone for patients with obstructive sleep apnea and nasal obstruction. Arch Otolaryngol Head Neck Surg. 2008; 134(4):429-433.
  19. Li HY, Wang PC, Chen YP, et al. Critical appraisal and meta-analysis of nasal surgery for obstructive sleep apnea. Am J Rhinol Allergy. 2011:25(1):45-49.
  20. Lin H, Friedman M, Chang H, et al. The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope. 2008; 118(5):902-908.
  21. Masdon JL, Magnuson JS, Youngblood G. The effects of upper airway surgery for obstructive sleep apnea on nasal continuous positive airway pressure settings. Laryngoscope. 2004; 114(2):205-207.
  22. Nakata S, Noda A, Yagi H, et al. Nasal resistance for determinant factor of nasal surgery in CPAP failure patients with obstructive sleep apnea syndrome. Rhinology. 2005; 43(4):296-299.
  23. Neace JM, Krempl GA. Radiofrequency treatment of turbinate hypertrophy, a randomized, blinded, placebo-controlled clinical trial. Otolarygol Head Neck Surg. 2004; 130(3):291-299.
  24. Nelson LM, Barrera JE. High energy single session radiofrequency tongue treatment in obstructive sleep apnea surgery. Otolaryngol Head Neck Surg. 2007; 137(6):883-888.
  25. Olson EJ, Park JG, Morgenthaler TI. Obstructive sleep apnea-hypopnea syndrome. Prim Care. 2005; 32(2):329-359.
  26. San Nicoló M, Stelter K, Sadick H, et al. Absorbable implant to treat nasal valve collapse. Facial Plast Surg. 2017; 33(2):233-240.
  27. San Nicoló M, Stelter K, Sadick H, et al. A 2-year follow-up study of an absorbable implant to treat nasal valve collapse. Facial Plast Surg. 2018; 34(5):545-550.
  28. Singh A, Patel N, Kenyon G, Donaldson G. Is there objective evidence that septal surgery improves nasal airflow? J Laryngol Otol. 2006; 120(11):916-920.
  29. Steward DL. Effectiveness of multilevel (tongue and palate) radiofrequency tissue ablation for patients with obstructive sleep apnea syndrome. Laryngoscope. 2004; 114(12):2073-2084.
  30. Stewart MG, Smith TL, Weaver EM, et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004; 130(3):283-290.
  31. Stolovitzky P, Sidle DM, Ow RA, et al. A prospective study for treatment of nasal valve collapse due to lateral wall insufficiency: Outcomes using a bioabsorbable implant. Laryngoscope. 2018; 128(11):2483-2489.
  32. Stuck BA, Sauter A, Hormann K, et al. Radiofrequency surgery of the soft palate in the treatment of snoring. A placebo controlled trial. Sleep. 2005; 28(7):847-850.
  33. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008; 5(2):173-178.
  34. Zonato AI, Bittencourt LR, Martinho FL, et al. Upper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients. Eur Arch Otorhinolaryngol. 2006; 263(5):481-486.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. American Academy of Otolaryngology-Head and Neck Surgery. Clinical Consensus Statement. Septoplasty with or without inferior turbinate reduction. 2015; 153(5):708-720.
  2. American Academy of Otolaryngology -- Head and Neck Surgery. Position Statement: Nasal Surgery and OSAS. September 8, 2017. Available at: https://www.entnet.org/resource/position-statement-nasal-surgery-and-osas/. Accessed on March 17, 2022.
  3. American Academy of Otolaryngology -- Head and Neck Surgery. Position Statement: Surgical Management of Obstructive Sleep Apnea. March 2, 2014. Available at: https://www.entnet.org/resource/position-statement-surgical-management-of-obstructive-sleep-apnea/. Accessed on March 17, 2022.
  4. American Academy of Otolaryngology -- Head and Neck Surgery. Position Statement: Treatment of Obstructive Sleep Apnea. June 9, 2021. Available at: https://www.entnet.org/resource/position-statement-treatment-of-obstructive-sleep-apnea/. Accessed on March 17, 2022.
  5. Aurora RN, Casey KR, Kristo D, et al. American Academy of Sleep Medicine (AASM). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep. 2010; 33(10):1408-1413. Available at: http://www.aasmnet.org/Resources/PracticeParameters/PP_SurgicalModificationsOSA.pdf. Accessed on March 17, 2022
  6. Epstein LJ, Kristo D, Strollo PJ, et al. American Academy of Sleep Medicine (AASM). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009; 5(3):263-276. Available at: http://www.aasmnet.org/Resources/ClinicalGuidelines/OSA_Adults.pdf. Accessed on March 17, 2022.     
  7. Kapur VK, Auckley DH, Chowdhuri S, et al. American Academy of Sleep Medicine (AASM). Clinical practice guideline for diagnostic testing for adult Obstructive Sleep Apnea: An AASM Clinical Practice Guideline. J Clin Sleep Med. 2017; 13(3):479-504.
  8. Kent D, Stanley J, Aurora RN, et al. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021; 17(12):2499-2505.
  9. Main C, Liu Z, Welch K, et al. Surgical procedures and non-surgical devices for the management of non-apneic snoring: a systematic review of clinical effects and associated treatment costs. Health Technol Assess. 2009; 13(3):iii, xi-xiv, 1-208.
  10. Rimmer J, Fokkens W, Chong LY, Hopkins C. Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database of Syst Rev. 2014;(12):CD006991.
  11. U.S. Food and Drug Administration (FDA). Center for Devices and Radiological Health Circulatory System Devices Panel. Somnoplasty System (Somnus Medical Technologies, Sunnyvale, CA). Summary of Safety and Effectiveness. No. K971450. July 17, 1997. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf/K971450.pdf. Accessed on March 17, 2022.
  12. U.S. Food and Drug Administration (FDA). Center for Devices and Radiological Health Circulatory System Devices Panel. Gyrus G I1 Radio-frequency workstation & accessories (Gyrus Medical Inc., Bartlett, TN). Summary of Safety and Effectiveness. No. K021777. August 26, 2002. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf2/k021777.pdf. Accessed on March 17, 2022.
  13. U.S. Food and Drug Administration (FDA). Center for Devices and Radiological Health Circulatory System Devices Panel. Latera Absorbable Nasal Implant (Spirox, Inc. Menlo Park, CA). Summary of Safety and Effectiveness. No. K161191. June 23, 2016. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf16/k161191.pdf. Accessed on March 10, 2021.
Websites for Additional Information
  1. American Academy of Sleep Medicine (AASM). Available at: https://aasm.org/clinical-resources/practice-standards/practice-guidelines/. Accessed on March 17, 2022.
Index

Latera Absorbable Nasal Implant
Nasal Turbinate Hypertrophy
Obstructive Sleep Apnea, Nasal Surgery for
Radiofrequency Ablation of Nasal Turbinates
Somnoplasty, Volumetric Tissue Reduction of Nasal Turbinates
Volumetric Tissue Reduction of Nasal Turbinates

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

History

Status

Date

Action

Reviewed

05/12/2022

Medical Policy & Technology Assessment Committee (MPTAC) review. Removed SURG.00096 Surgical and Ablative Treatments for Chronic Headaches from Description section. Updated Discussion, References, and Websites sections.

Reviewed

05/13/2021

MPTAC review. Definitions and References were updated. Reformatted Coding section; removed 30999 no longer applicable.

 

12/16/2020

Updated Coding section with 01/01/2021 CPT and HCPCS changes; added 30468, code C9749 deleted 12/31/2020.

Reviewed

05/14/2020

MPTAC review. References were updated.

Reviewed

06/06/2019

MPTAC review. The Discussion and References sections were updated.

New

07/26/2018

MPTAC review. Moved content of SURG.000074 Nasal Surgery for the Treatment of Obstructive Sleep Apnea and Snoring to new clinical utilization management guideline document with the same title. Removed acronym (OSA) from the title. The References section was updated.


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