Medicaid covers uvulopalatopharyngoplasty for the treatment
of obstructive sleep apnea syndrome if all of the following are present:
A. Documented obstructed sleep apnea (OSA)
with apnea hypopnea index (AHI) or respiratory disturbance index (RDI) which
meets the following parameters in a) or b) below:
1. UPPP/UP3 as sole procedure: with AHI/RDI
greater than fifteen (15) and less than forty (40), or AHI/RDI ten (10) to
fifteen (15) with one (1) or more of the conditions listed below:
a) Hypertension,
b) Cardiac arrhythmias predominately during
sleep,
c) Pulmonary hypertension,
d) Documented ischemic heart
disease,
e) Impaired cognition or
mood disorders,
f) History of
stroke, or
g) Excessive daytime
sleepiness, as documented by either a score of greater than ten (10) on the
Epworth Sleepiness Scale or inappropriate daytime napping such as during
driving, conversation, or eating, or sleepiness that interferes with daily
activities.
2. UPPP/UP3
as part of a planned staged or combined surgery aimed at also relieving retro
lingual obstruction such as genioglossal advancement, hyoid myotomy and
suspension: with AHI/RDI greater than fifteen (15), or AHI/RDI ten (10) to
fifteen (15) with one (1) or more of the conditions listed below:
a) Hypertension,
b) Cardiac arrhythmias predominately during
sleep,
c) Pulmonary hypertension,
d) Documented ischemic heart
disease,
e) Impaired cognition or
mood disorders,
f) History of
stroke, or
g) Excessive daytime
sleepiness, as documented by either a score of greater than ten (10) on the
Epworth Sleepiness Scale or inappropriate daytime napping, (e.g., during
driving, conversation, or eating) or sleepiness that interferes with daily
activities.
B. Continuous positive airway pressure (CPAP)
has been tried with well-supported follow-up and clearly failed or is not
tolerated.
C. Pre-operative
evaluation including fiber optic endoscopy suggest retro-palatal narrowing is
the primary source of airway obstruction if UPPP/UP3 is the sole procedure or a
combined surgery aimed at also relieving retro lingual obstruction.
Miss. Code Ann. §
43-13-121
