The patient has sleep apnea. The apnea hypopnea index (AHI) is 17.4 The body mass index (BMI) is 28.4. The patient cannot tolerate continuous positive airway pressure (CPAP) or an oral appliance. Sleep endoscopy did not reveal concentric collapse at level of oropharynx or hypopharynx.
A Hypoglossal nerve stimulator (HGNS) is being requested and is the subject of this review.

The health plan's determination is overturned. The Outpatient Surgery Services: Upper Airway Stimulation is medically necessary for this patient. The patient has sleep apnea and cannot tolerate CPAP. The patient has an AHI between 15 and 65 and a BMI less than 32. Sleep endoscopy did not reveal oropharyngeal or hypopharyngeal concentric collapse. The treating provider does not feel that there are reasonable surgical alternatives. Based on the patient not being able to tolerate the first line therapy for sleep apnea, CPAP, and that there are no reasonable surgical options, the hypoglossal nerve implant is a medically necessary treatment. There is good literature demonstrating safety and efficacy. It is likely that the patient will have significant improvement in his sleep apneas symptoms and decreased long term morbidity if the implant is placed.