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Prior Authorization Criteria for Surgical Implantation of HNS Effective March 1, 2022 for the CSHCN Services Program

Last updated on 1/14/2022

Beginning March 1, 2022, prior authorization criteria will be in effect for hypoglossal nerve stimulator (HNS) procedure code 64582.

HNS procedure code 64582 is a new 2022 Healthcare Common Procedure Coding System procedure code that has been made a benefit of the Children with Special Health Care Needs (CSHCN) Services Program.

Prior Authorization Requirements

The surgical implantation of an HNS (procedure code 64582) and purchase of a device will be considered for prior authorization with documentation of the following criteria:

  • Client has a documented diagnosis of obstructive sleep apnea (OSA) or seizures from a qualified health-care provider.
  • For an OSA diagnosis, requests must include documentation that the client’s compliant use of continuous positive airway pressure (CPAP) for a minimum of 1 month (5 nights per week for at least 4 hours per night) has not been successful or cannot be tolerated.
  • For an OSA diagnosis, complete concentric collapse at the soft palate level as seen in a drug-induced sleep endoscopy (DISE) procedure must be absent.

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.