Otolaryngology Coding Alert

Answer: Radiofrequency to eliminate snoring is considered a cosmetic service and is not covered by most payers. 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, also called snoreplasty, 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. There isn’t a need to have the patient sign an advanced beneficiary notice (ABN) for this service if it’s statutorily excluded from coverage, but it may be a good idea to ask them to sign one anyway, just so everyone is clear on the payment responsibility and the projected cost of the service.