Otolaryngology Coding Alert

Question: How should I code radiofrequency reduction of the soft palate?

Indiana Subscriber

Answer: Radiofrequency to eliminate snoring, is considered a cosmetic service and is not covered. The situation is more complicated for patients with sleep disorders. Although many Medicare carriers do not cover radiofrequency for soft-palate reduction, usually noting that the procedure remains unproven clinically, others will pay for the procedure. The situation is similar among private carriers.

CPT does not include a code for soft-palate reduction, whether by radiofrequency or laser-assisted uvulopalato-plasty (LAUP). If a predetermination of payment is obtained or if a denial is required to allow a third party to pay for the procedure, 42299 (Unlisted procedure, palate, uvula) may be used. Some private carriers may accept 42145 (Palatopharyngoplasty [e.g., uvulopalatopharyngo-plasty, uvulopharyngoplasty]) with modifier -52 (Reduced services) appended to indicate that, as with LAUP, a complete uvulopalatopharyngoplasty was not performed. Never report 42145 to Medicare carriers for LAUP or somnoplasty; report 42145 to private payers only if requested to do so by the carrier.