| Surgery Section - Surgeries for Snoring, Obstructive
Sleep Apnea Syndrome and Upper Airway Resistance
Syndrome In Adults
| Topic: Surgeries for
Snoring, Obstructive Sleep Apnea Syndrome and
Upper Airway Resistance Syndrome In Adults |
Date of Origin: 03/31/2009 |
| Section: Surgery |
Policy No: 166 |
| Approved Date: 06/09/2009 |
Effective Date: 07/01/2009 |
| Next Review Date: 07/2010 |
|
| |
IMPORTANT REMINDER
This Medical Policy has been developed through consideration of medical necessity,
generally accepted standards of medical practice, and review of medical literature
and government approval status.
Benefit determinations should be based in all cases on
the applicable contract language. To the extent there are any conflicts
between these guidelines and the contract language, the contract language will
control.
The purpose of medical policy is to provide a guide to coverage. Medical Policy
is not intended to dictate to providers how to practice medicine. Providers
are expected to exercise their medical judgment in providing the most appropriate
care.
DESCRIPTION
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea syndrome may be present when a person repeatedly
stops breathing (apnea) for at least 10 seconds or longer during sleep.
These apneic episodes are followed by lack of adequate oxygen intake
with brief awakenings and usually occur many times during the night.
Hypopnea, or reduced airflow, may also occur with OSA. Hypopnea
is defined as an abnormal respiratory event lasting at least 10 seconds
with at least a 30% reduction in airflow and a fall in oxygen saturation
of a least 3%-4%. OSA is caused by a blockage of the airway, usually
when the soft tissue at the back of the throat collapses during relaxed
sleep, closing off the airway. The hallmark clinical symptom of OSA is
excessive snoring, although it is important to note that snoring can
occur in the absence of OSA.
A polysomnogram performed in a sleep laboratory is considered the gold
standard test used to diagnose OSA. The apnea index consists of the total
number of apneic events per hour of sleep. Apneic and hypopneic
events are combined into the apnea-hypopnea index (AHI) which may also
be referred to as the respiratory disturbance index (RDI). When sleep
onset and offset are unknown, the RDI may be calculated based on the
total recording time. The final diagnosis of OSA rests on a combination
of objective and subjective criteria (e.g. AHI and excessive daytime
sleepiness) that seek to identify those levels of obstruction which are
clinically significant. The following AHI levels are used for the
diagnosis of OSA:
- AHI between 5 and 15 is considered mild sleep apnea.
- An AHI of greater than or equal to 15 is typically considered moderate
OSA
- AHI of greater than 50 is considered severe OSA
An increase in mortality is associated with an AHI greater than 15.
More difficult to evaluate is the clinical significance of patients with
mild sleep apnea. Mortality has not been shown to be increased
in these patients, and frequently the most significant manifestations
reported by the patient are snoring, excessive daytime sleepiness, or
hypertension. Isolated snoring in the absence of medical complications,
while troubling to the patient’s bed partner, is not considered
a medical problem requiring surgical intervention.
Upper airway resistance syndrome (UARS)
Upper airway resistance syndrome (UARS) is a variant of OSA which is
characterized by a partial collapse of the airway resulting in increased
resistance to airflow. Snoring may not be a feature of UARS. The resistance
to airflow does not result in stopped breathing. The increased respiratory
effort required to move air into the lungs results in fragmented sleep.
Diagnosis of UARS is more subtle than OSA. This sleep disturbance can
be measured by electroencephalogram (EEG) and a drop in airway pressure
in the chest as measured by a variety of tests including use of an esophageal
manometer as part of a polysomnogram. Diagnosis of UARS rests on documentation
of >10 EEG arousals per hour of sleep along with documented episodes
of reduced intrathoracic pressure associated with the EEG arousals. The
presence of abnormally negative intrathoracic pressures (i.e., more negative
than -10 cm) in conjunction with the EEG arousals supports the UARS diagnosis.
Since not all sleep labs have access to esophageal manometry, esophageal
manometry is not required to confirm UARS.
See Appendix 1 for additional information on diagnostic tests for OSA
and UARS.
Surgical Treatments for OSA and UARS
Medical therapy is considered the first-line treatment for OSA and UARS.
These therapies include weight loss, various continuous positive airway
pressure (CPAP) devices, or orthodontic repositioning devices. See Appendix
2 for a description of medical devices used in the treatment of OSA and
UARS. Most guidelines consider surgical intervention only after
all medical treatments for OSA or UARS have failed.
Uvulopalatopharyngoplasty (UPPP)
Conventional surgeries for OSA include uvulopalatopharyngoplasty (UPPP)
and a variety of maxillofacial surgeries such as mandibular-maxillary
advancement (MMA). UPPP involves surgical resection of the mucosa
and submucosa of the soft palate, tonsillar fossa, and the lateral aspect
of the uvula. The UPPP procedure enlarges the oropharynx but cannot
correct obstructions in the hypopharynx. Thus patients who fail UPPP
may be candidates for additional procedures such as mandibular and maxillary
advancement surgery.
Mandibular and maxillary advancement surgery (MMA)
Mandibular and maxillary advancement surgeries are more extensive and
proposed for patients who do not have an adequate response to UPPP. These
surgeries may be used to correct obstruction of the hypopharynx, the
area at the very back of the throat.
Laser assisted uvuloplasty (LAUP)
LAUP is an outpatient alternative that has been proposed as a treatment
of snoring with or without associated OSA. In this procedure, the tissues
of the soft palate (palatal tissues) are reshaped using a laser. The
extent of the surgery is typically different than standard UPPP, since
only part of the uvula and associated soft-palate tissues are reshaped.
The procedure, as initially described, does not remove or alter tonsils
or lateral pharyngeal wall tissues. The patient undergoes from 3 to 7
sessions at 3- to 4-week intervals LAUP cannot be considered an equivalent
procedure to the standard UPPP, with the laser simply representing a
surgical tool that the physician may opt to use. LAUP is considered a
unique procedure, raising unique issues of safety and effectiveness.
Radiofrequency ablation of the soft palate/volumetric reduction of
the tongue base (RFTBR)
Radiofrequency ablation of the soft palate and tongue is similar in
concept to LAUP, although a different energy source is used. Radiofrequency
energy is used to produce thermal lesions within the tissues, rather
than using a laser to ablate the tissue surface, which may be painful.
These procedures may also be referred to as a somnoplasty after the Somnoplastysm
System device (Somnus Medical Technologies, Sunnyvale, CA) which was
FDA approved through the 510(k) process.
Cautery assisted palatal stiffening procedure (CAPSO)
This palatal stiffening procedure uses cautery (electrically heated
probes) to induce a midline palatal scar designed to stiffen the soft
palate to eliminate excessive snoring.
Pillar palatal implant procedure
The Pillar™ Palatal Implant System (Restore Medical, St. Paul,
MN) is an implantable cylindrical-shaped device that is permanently implanted
in the soft palate (the soft area at the back of the upper mouth). The
device was cleared for marketing by the FDA through the 510(k) process
with the labeled indication as follows:
“The Pillar™ Palatal Implant System is intended for the
reduction of the incidence of airway obstructions in patients suffering
from mild to moderate OSA (obstructive sleep apnea).”
Suspension of the tongue base
The Repose™ device involves the use of a titanium screw which
is inserted into the posterior aspect of the lower jaw at the floor of
the mouth. A loop of suture is passed through the tongue base and
attached to the mandibular bone screw. The Repose™ procedure achieves
a suspension or hammock of the tongue base making it less likely for
the base of the tongue to drop backward during sleep.
Uvulectomy
This procedure surgically removes the uvula, the small tissue hanging
from the soft palate at the back of the throat above the tongue. The
uvula, which helps stiffen and shape the back of the throat and prevents
food from going down the airway, is believed to be associated with excessive
snoring.
Partial Glossectomy
This procedure surgically removes of a portion of the tongue or oral
cavity in an effort to widen the hypopharynx.
POLICY/CRITERIA
- Surgical Treatment of Snoring Alone
Surgical intervention for the treatment of snoring in the absence of
documented obstructive sleep apnea is considered not medically necessary.
- Surgical Treatment of Obstructive Sleep Apnea (OSA) and Upper
Airway Resistance Syndrome (UARS)
- Procedures
- The following procedures may be considered medically necessary
for the treatment of OSA and UARS when the criteria in either
II.B and II.C or II.B and II.D below are met:
- Hyoid suspension
- Mandibular-maxillary advancement (MMA) when there is
objective documentation of hypopharyngeal
obstruction
- Uvulopalatopharyngoplasty (UPPP) with or without inferior
sagittal osteotomy with hyoid suspension
- All other procedures are considered investigational
as treatments of OSA or UARS, including but not limited
to:
- Uvulectomy
- Partial glossectomy
- Radiofrequency volumetric tissue reduction of
the tongue base or palatal tissues
- Tongue base suspension procedures, including but
not limited to the Repose™
- Laser-assisted palatoplasty (LAUP) or volumetric
tissue reduction
- Palatal stiffening procedures such as cautery-assisted
palatal stiffening operation (CAPSO)
- Implantation of palatal implants (also known as
the pillar procedure).
- Failed Medical Therapy
All of the following medical therapies have failed:
- Nasal CPAP – An adequate CPAP trial must be
documented. An adequate CPAP trial is defined
as a minimum of four hours per night for three weeks
of CPAP usage and documentation of reasonable attempts
to address any problems associated with CPAP. (Problems
may include lack of improvement in apnea/hypopnea
or persistent excessive daytime sleepiness, severe
adverse nasal or sinus reaction to CPAP not controlled
with medication and humidification, or severe psychological
aversion to CPAP not responsive to a desensitization
program).
- Maximal medical treatment of any underlying disease
- Adjustment in sleep position
- Avoidance of alcohol and sedative drugs
- Obstructive Sleep Apnea
The patient has clinically significant OSA as defined below
- An AHI equal to or greater than 15; OR
- An AHI between 5 and 14 with any of the following
associated symptoms:
- Excessive daytime sleepiness that is not better
explained by other factors
- Documented hypertension
- Ischemic heart disease
or congestive heart failure
- History of stroke
- Obesity
- Diabetes and glucose intolerance
- Two or more of the following that are not better
explained by other factors:
- Choking or gasping during sleep
- Recurrent awakenings during sleep
- Unrefreshing sleep with daytime fatigue
- Impaired concentration or cognition
- Insomnia
- Upper Airway Resistance Syndrome
The patient has clinically significant UARS defined as greater
than 10 alpha EEG arousals per hour.
Note: Some member contracts have specific benefit
limitations for orthognathic surgery.
POSITION SUMMARY
- Snoring in the absence of clinically significant OSA is not considered
a medical condition. Therefore, any surgical intervention such as UPPP,
LAUP, radiofrequency volumetric tissue reduction of the palate, or palatal
stiffening procedures, for snoring alone is considered not medically
necessary.
- Conventional uvulopalatalpharyngoplasty (UPPP) and maxillofacial
surgeries such as mandibular-maxillary advancement (MMA) may improve
health outcomes for some patients with OSA. These surgical
treatments are considered only after failed medical therapy and
failed CPAP trials.
- Evidence is uncertain for use of any other surgical interventions
in the treatment of OSA including but not limited to uvulectomy, partial
glossectomy, tongue base reduction and minimally invasive surgical
procedures such as laser-assisted uvuloplasty (LAUP), radiofrequency
tongue base or tissue volume reduction, pillar stiffening procedures
and pillar implants.
Effectiveness
The evidence suggests conventional uvulopalatalpharyngoplasty (UPPP)
and maxillofacial surgeries such as mandibular-maxillary advancement
(MMA) may improve health outcomes for some patients with OSA who have
failed medical therapies for OSA.
- The available evidence does not currently support the widespread use
of surgical interventions in the management of unselected patients with
obstructive sleep apnea. Given the proven efficacy of CPAP in patients
with moderate and severe symptoms and significant sleep disordered breathing,
surgery cannot be recommended as a front line therapy, ahead of positive
airways pressure systems. (4,5,6)
- While studies on UPPP and hyoid suspension procedures were not
randomized, data from ten studies which included more than 750 patients
consistently reported improved outcomes for patients with OSA as
measured by postoperative polysomnographic assessment of sleep disturbance
and compared with concurrent groups being treated with CPAP. (7)
- UPPP and MMA procedures are widely practiced among surgeons in the
United States. These procedures have been considered a standard of
care in the medical community. (7)
- American Academy of Sleep Medicine (AASM) Practice Parameters suggest
UPPP is treatment of choice for those not responding to medical therapy.
(8)
Evidence is uncertain for use of any other surgical interventions in
the treatment of OSA, including but not limited to uvulectomy, partial
glossectomy, tongue base reduction and minimally invasive surgical procedures
such as laser-assisted uvuloplasty (LAUP), radiofrequency tongue base
reduction (RFTBR), pillar stiffening procedures and pillar implants.
- A recently updated Cochrane review on surgery for OSA reports there
are a limited number of trials assessing diverse surgical techniques.
Inconsistent effects were reported across all trials. The report concludes
evidence from these small studies does not currently support the widespread
use of surgery in people with mild to moderate daytime symptoms associated
with sleep apnea. (5)
- Most trials are limited to unreliable case series and retrospective
reviews that do not permit conclusions on the effectiveness or safety
of these procedures for the treatment of OSA and UARS. Lack of comparison
groups, randomization, and failure to define study endpoints or
treatment success prior to commencement may introduce bias in favor
of the new technology. In addition, retrospective study designs
do not allow for control of co-treatments or confounding factors
that may influence results. (5,7-9,10-36)
- Results reported in published randomized studies do not show a consistent
benefit across all trials. In addition, conclusions cannot be reached
on safety and effectiveness from these trials due poor study design
including small sample size, lack of blinding, unclear allocation of
concealment, incomplete data outcomes reported, or enrollment of subjects
with low AHI scores indicating a patient population that may not be
considered for surgery. (5, 8, 35-51)
- The current AASM 2001 Practice Parameters for use of laser-assisted
uvulopalatoplasty do not recommend LAUP for the treatment of sleep
related breathing disorders including OSA. These guidelines state
LAUP is not recommended as a substitute for UPPP.(8)
Safety
Long-term safety and effectiveness of minimally invasive surgical procedures
have not been established.
Potential surgical complications include nasal regurgitation, bleeding,
dysphagia, infection, airway obstruction leading to tracheostomy, and
extrusion of implants.
Risk of lingual nerve injury resulting in numbness to the teeth, tongue,
lips or slurred speech has been reported with some tongue-base reduction
and partial glossectomy procedures.
| Appendix
1: Procedures
for the Diagnosis of Sleep Disordered Breathing |
Polysomnography (PSG) |
Full night PSG consists of five
to eight hours of monitoring, supervised by a
sleep technician, while the patient sleeps. It
is performed in a sleep lab and involves the
following monitoring modalities: electroencephalogram
(EEG) (to stage sleep and detect arousals), electro-oculogram
(EOG) (to detect arousal and REM sleep) submental
electromyogram, (EMG), electrocardiogram (EKG),
two-leg EMG, respiratory airflow and effort (to
detect apnea), snoring, oxygen saturation, time
and position. In addition, a full night
PSG may include additional monitoring modalities
as indicated, such as esophageal pressure monitoring,
blood pressure monitoring, carbon dioxide trends,
and pulse transit time.
The first three elements listed above (EEG,
submental electromyogram, and electro-oculogram)
are required for sleep staging. By definition,
a polysomnogram always includes sleep staging,
while a “sleep study” does not
include sleep staging. The actual components
of the study will be dictated by the clinical
situation. Typically, the evaluation of obstructive
sleep apnea would include respiratory airflow
and effort, electro-oculogram, and oxygen desaturation.
An EEG may not be considered necessary to evaluate
OSA, although it is required to evaluate UARS,
REM sleep behavior disorder (RBD), narcolepsy
or other sleep disturbances. |
Split Night
Polysomnography |
A split night study utilizes
the first two or three hours for evaluating the
presence of sleep apnea and the second half to
titrate and adjust CPAP. The same monitoring
modalities used in full night PSG are used in
split night study. In patients with severe obstructive
sleep apnea, a reliable assessment of the respiratory
disturbance index is possible with a partial
night study. Half night study for CPAP titration
is reliable in selected cases of obstructive
sleep apnea.
Split night studies are appropriate in patients
with severe sleep apnea syndrome. The decision
to conduct a split night study depends on the
technical skill and experience of the staff,
the initial sleep latency period, the severity
and frequency of respiratory events and patient
compliance. Careful patient selection and education
is required to conduct a successful split night
study. |
Ambulatory or Portable
Home Monitoring Device (PM) |
A
variety of portable polysomnography monitors
are available for use in the home setting. Available
devices evaluate different parameters including
oximetry, respiratory and cardiac monitoring,
and sleep/wake activity, but the majority of
portable monitors do not record EEG. While
evidence indicates that portable monitoring can
be a safe and effective method to evaluate OSA,
there is a lack of standardization among devices
and additional study is needed to determine the
most reliable types of devices and combinations
of home monitoring.
The following information may be useful in
determining whether to use a portable home
monitoring device (3):
- Portable monitoring should only be conducted
in patients with a high pretest probability
of OSA and absence of comorbid conditions as
determined by clinical evaluation.
- A positive portable study with at least 3
channels of recording (e.g., arterial oxygen
saturation, airflow, respiratory effort, or
heart rate) has a high positive predictive
value for OSA and can be used as the basis
for a CPAP trial to determine efficacy of treatment.
- A negative study can not be used to rule
out OSA. Patients who have a negative result
from portable monitoring or who do not respond
to CPAP should undergo further evaluation.
- Due to the probability of artifacts or loss
of data, raw data from the portable monitoring
device should be reviewed by a sleep specialist.
- Follow-up and review of the APAP trial is
also needed.
|
SNAP™ Testing |
The SNAP testing system is a
reflective acoustic device marketed as a screening
and analysis system to locate the source of snoring
and detect sleep apnea conditions. |
Multiple Sleep Latency
Tests (MSLT) |
The MSLT measures the speed of
falling asleep under conditions that favor sleep,
in a series of 20-minute trials during the patient’s
habitual periods of wakefulness. MSLT is the
preferred method of establishing the presence
of true physiological sleepiness but is accurate
only if following strict protocols. MSLT is used
in patients with complaints of irresistible daytime
sleepiness suggestive of narcolepsy. |
Maintenance of Wakefulness
Test (MWT) |
The patient is monitored during
the usual periods of wakefulness but the patient
is instructed not to fall asleep as a test of
the patient’s ability to stay awake. It
may be used to evaluate the safety of drivers
and their ability to stay alert. |
Radiologic Studies |
Radiologic images of the head
and neck for anatomic abnormalities include MRI,
CT scan, and cephalometry. Such studies are intended
to assess for hypopharyngeal obstruction or other
suspected pathology that might explain the symptoms
associated with sleep disordered breathing. |
Endoscopic Studies |
Nasopharyngeal and laryngeal
endoscopic measurements of structure and function
of the upper airway are used in selected patients
with suspected abnormal anatomy as an aid in
the diagnosis of OSA or in the management of
complications of treatment. |
Epworth Sleepiness Scale |
Excessive daytime sleepiness
is predominantly a subjective symptom. The
Epworth sleepiness scale is a self-administered
questionnaire, performed as part of the clinical
evaluation, that asks patients their likelihood
of falling asleep in eight situations ranked
from 0 (would never fall asleep) to 3 (high chance
of dozing). The numbers are then added
together to give a global score between 0 and
24. A value of 10 or below is considered
normal. |
Apnea-Hypopnea Index
(AHI); Respiratory Disturbance Index (RDI) |
Apnea is defined as the cessation
of respiration for at least 10 seconds. Hypopnea
is a reduction but not cessation of air exchange.
Apneic and hypopneic events are combined into
the apnea-hypopnea index (AHI). In turn the AHI
is often referred to as the respiratory disturbance
index (RDI), although more recently the RDI has
been redefined by some physicians to include
EEG arousals in addition to apneic and hypopneic
events. An AHI of greater than or equal
to 20 is typically considered moderate OSA, and
AHI of greater than 50 is considered severe OSA.
An increase in mortality is associated with an
AHI of greater than 15. |
| Appendix
2: Nonsurgical Devices for Treatment of OSA or
UARS |
CPAP |
Nasal or oral continuous positive
airway pressure (CPAP) or auto-titrating continuous
positive airway pressure (APAP) is continuous
positive airway pressure applied through the
nose or via oral appliance. It is delivered by
a flow generator through a mask to supply a pressure
level sufficient to keep the upper airway patent.
The pressure used is determined individually
with a range of three to 15 centimeters of water. |
BiPAP® |
Bi-level respiratory assist device
delivers alternating levels of positive airway
pressure instead of the continuous pressure applied
by CPAP.
A bi-level positive airway pressure device
with back-up rate feature is a ventilation
support system. These devices are in the FDA
category of non-continuous ventilator, and
as such, are primarily intended to augment
patient ventilation.
The term BiPAP® is a registered trademark
of Respironics Inc., but is widely used
to describe any bi-level positive airway pressure
device as described above. |
APAP |
Auto-adjusting CPAP (APAP) is
a more recent technology which alternates airway
pressure between exhalation and inhalation on
a breath-by-breath basis. With the C-Flex™ (Respironics,
Inc) airway pressure is reduced during early
exhalation in proportion to the patient’s
expiratory flow rate. Pressure is then
increased again toward the end of exhalation
when airway collapse is most likely. Unlike
BiPAP which delivers a static lower expiratory
pressure, the C-Flex varies the pressure within
the expiratory phase. |
Oral Appliances (OA) |
OA for the treatment of sleep
disordered breathing are devices worn in the
mouth during sleep to maintain a patent airway
by raising the uvula, depressing the tongue,
and/or advancing the mandible. Commercially available
devices are usually custom-molded or custom-fitted
for the individual patient by a qualified dental
health professional trained and experienced in
the overall care of oral health, the temporomandibular
joint, dental occlusion and associated oral structures. According
to the American Academy of Sleep Medicine, dental
management of patients with oral appliances should
be overseen by practitioners who trained in sleep
medicine and sleep related breathing disorders.
(52, 53 ) Oral appliances can range from
simple retaining devices, to adjustable, hinged,
or two-piece designs. Some designs can be used
in conjunction with a CPAP device (e.g., OPAP®). |
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Cross References
Orthognathic Surgery, Regence Medical Policy Manual, Surgery, Policy No. 137
| Codes |
Number |
Description |
| Note: There
is no specific CPT code for the tongue base reduction
procedure. The most appropriate code to use
is 41599 (unlisted procedure). 41120 (partial
glossectomy) describes a surgical resection and
is not the appropriate code to use for submitting
claims for tongue base reduction. |
| CPT |
0088T |
Sub mucosal radiofrequency
tissue volume reduction of tongue base, one or
more sites, per session (i.e., for treatment
of obstructive sleep apnea syndrome) (Deleted
01/01/09)
|
| |
21121 |
Genioplasty; sliding
osteotomy, single piece |
| |
21122 |
Genioplasty; sliding
osteotomies, two or more osteotomies (eg, wedge
excision or bone wedge reversal for asymmetrical
chin) |
| |
21141 |
Reconstruction midface,
LeFort 1;single piece, segment movement in any
direction (eg, for Long Face Syndrome), without
bone graft |
| |
21142 |
Reconstruction midface,
LeFort 1; 2 pieces, segment movement in any direction,
without bone graft |
| |
21143 |
Reconstruction midface,
LeFort 1; 3 or more pieces, segment movement
in any direction, without bone graft |
| |
21145 |
Reconstruction midface,
LeFort 1; single piece, segment movement in any
direction, requiring bone grafts (includes obtaining
autografts) |
| |
21146 |
Reconstruction midface,
LeFort 1; 2 pieces, segment movement in any direction
(includes obtaining autografts) (eg, ungrafted
unilateral alveolar cleft or multiple osteotomies), |
| |
21147 |
Reconstruction midface,
LeFort 1; 3 or more pieces, segment movement
in any direction, requiring bone grafts (includes
obtaining autografts) (eg, ungrafted bilateral
alveolar cleft or multiple osteotomies) |
| |
21196 |
Reconstruction of
mandibular rami and /or body, sagittal split;
with internal rigid fixation |
| |
21198 |
Osteotomy, mandible,
segmental |
| |
21199 |
Osteotomy, mandible,
segmental; with genioglossus advancement |
| |
21685 |
Hyoid myotomy and
suspension |
| |
41120 |
Glossectomy; less
than one-half tongue |
| |
41500 |
Fixation of tongue,
mechanical, other than suture (e.g., K-wire) |
| |
41512 |
Tongue base suspension,
permanent suture technique |
| |
41530 |
Submucosal ablation
of the tongue base, radiofrequency, one or more
sites, per session |
| |
42140 |
Uvulectomy, excision
of uvula |
| |
42145 |
Palatopharyngoplasty
(e.g., Uvulopalatopharyngoplasty, Uvulopharyngoplasty) |
| |
42160 |
Destruction of lesion,
palate or uvula (thermal, cryo, or chemical) |
| HCPCS |
S2080 |
Laser-assisted uvulopalatoplasty
(LAUP) |
Surgery Section Table of Contents 
|
