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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

July 2015

Coverage of Oral Devices for Obstructive Sleep Disorder 


Harvard Pilgrim has developed a new medical policy for the use of oral devices to treat obstructive sleep apnea. Oral devices help keep the patient’s airway open during sleep, promoting adequate air intake and helping to prevent hypoxia (a deficiency in the amount of oxygen reaching the tissues), hypercapnia (excessive carbon dioxide in the bloodstream), and acidosis (excessive acidity of body fluids).

Effective immediately, Harvard Pilgrim covers FDA-approved, physician-ordered mandibular oral devices to treat mild to moderate obstructive sleep apnea in members for whom all of the following criteria apply:

  • Appropriate sleep testing has confirmed the presence of obstructive sleep apnea.
  • The oral device is ordered by the physician (PCP or specialist) who is treating the member for obstructive sleep apnea.
  • The patient has a documented intolerance of CPAP or BiPAP.
  • The patient has adequate dentition to support the device.
  • The patient has at least 7 mm of protrusive jaw movement from a position of maximum intercuspation.
  • The patient has a patent nasal airway.
  • The patient has no TMJ restriction, painful or loud TMJ noises, or local sites of severe joint or muscle tenderness.

Harvard Pilgrim does not cover the use of over-the-counter oral devices. For complete information, please refer to the Oral Devices for Obstructive Sleep Apnea Medical Policy posted on Harvard Pilgrim’s provider website.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator