Aetna · Clinical coverage policy

Aetna Obstructive Sleep Apnea in Children coverage criteria

Aetna CPB 0752 covers diagnosis and treatment of obstructive sleep apnea (OSAS) in children under 18. Facility-based nocturnal polysomnography is covered for diagnosis and for specified high-risk post-surgical reassessment, and covered treatments include adenotonsillectomy, CPAP, lingual tonsillectomy/tongue-base reduction, oral appliances for craniofacial anomalies, palatopharyngoplasty in neuromuscular cases, supraglottoplasty for laryngomalacia, and hypoglossal nerve stimulation for adolescents with Down syndrome who meet strict AHI and PAP-failure criteria. The key gate is documented OSAS (e.g., apnea index greater than 1 on polysomnography) with the appropriate clinical indication; many screening tools, drug therapies, biomarkers, and surgical/orthodontic procedures are deemed experimental or not covered as dental.

Policy CPB 0752 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0752

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0752 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Obstructive Sleep Apnea in Children (CPT 95808), and what gets it denied?

Path
Aetna CPB 0752 covers diagnosis and treatment of obstructive sleep apnea (OSAS) in children under 18. Facility-based nocturnal polysomnography is covered for diagnosis and for specified high-risk post-surgical reassessment, and covered treatments include adenotonsillectomy, CPAP, lingual tonsillectomy/tongue-base reduction, oral appliances for craniofacial anomalies, palatopharyngoplasty in neuromuscular cases, supraglottoplasty for laryngomalacia, and hypoglossal nerve stimulation for adolescents with Down syndrome who meet strict AHI and PAP-failure criteria. The key gate is documented OSAS (e.g., apnea index greater than 1 on polysomnography) with the appropriate clinical indication; many screening tools, drug therapies, biomarkers, and surgical/orthodontic procedures are deemed experimental or not covered as dental. Coverage criteria include: Diagnosis - Nocturnal polysomnography (NPSG) is medically necessary for children and adolescents younger than 18 years, performed in a healthcare facility, for ANY ONE of the following indications: diagnosing OSAS and differentiating it from primary snoring; OR evaluating hypersomnia; OR suspected narcolepsy (in conjunction with MSLT); OR suspected parasomnia; OR suspected restless leg syndrome; OR suspected periodic limb movement disorder; OR suspected congenital central alveolar hypoventilation syndrome; OR suspected sleep-related hypoventilation due to neuromuscular disorders or chest wall deformities.; Diagnosis - NPSG after adenotonsillectomy or other pharyngeal surgery for OSAS is medically necessary when ANY ONE of the following is present: age younger than 3 years; OR cardiac complications of OSAS (e.g., right ventricular hypertrophy); OR craniofacial anomalies obstructing the upper airway; OR failure to thrive; OR neuromuscular disorders (e.g., Down syndrome, Prader-Willi syndrome, myelomeningocele); OR obesity; OR prematurity; OR recent respiratory infection; OR severe OSAS on pre-operative PSG (RDI greater than or equal to 19); OR OSAS symptoms persist after treatment. The post-operative study should be delayed 6 to 8 weeks after surgery.; Diagnosis - Drug-induced sleep endoscopy (DISE) is medically necessary for surgical planning in children up to age 18 years who have persistent documented OSAS that is refractory to non-invasive therapy and who are eligible for surgery.; Treatment - Hypoglossal nerve neuro-stimulation (e.g., Inspire II / Inspire 3028 Upper Airway Stimulation system) is medically necessary for adolescents with Down syndrome when ALL of the following criteria are met: age 13 to 18 years; AND AHI greater than 10 and less than 50; AND absence of complete concentric collapse at the soft palate level; AND the member is contraindicated for or not effectively treated by adenotonsillectomy; AND the member has failed or is intolerant of PAP therapy despite attempts at compliance; AND the member has followed the standard of care with consideration of alternative or adjunct therapies.; Treatment - Treatment for OSAS in children with habitual snoring is indicated when the apnea index is greater than 1 on NPSG; the following treatment modalities are addressed below.; Treatment - Adenoidectomy and/or tonsillectomy is medically necessary for treatment of OSAS in children with habitual snoring (apnea index greater than 1 on NPSG); Aetna notes that the majority of children benefit from this procedure.; Treatment - Continuous positive airway pressure (CPAP) is medically necessary for treatment of OSAS in children with habitual snoring when ANY ONE of the following applies: adenoidectomy/tonsillectomy is contraindicated; OR adenoidectomy/tonsillectomy is delayed; OR adenoidectomy/tonsillectomy was unsuccessful. CPAP is also medically necessary for tracheomalacia.; Treatment - Lingual tonsillectomy and/or tongue base reduction is medically necessary to treat tongue base collapse in children with persistent OSA after adenotonsillectomy (e.g., children with obesity, Down syndrome, or craniofacial/neuromuscular disorders).; Treatment - Oral appliances or functional orthopedic appliances are medically necessary for children with craniofacial anomalies who show signs and symptoms of OSAS. (Note: considered experimental/investigational/unproven for otherwise healthy children.); Treatment - Palatopharyngoplasty (including UPPP/uvulopalatopharyngoplasty, uvulo-pharyngoplasty, uvulo-palatal flap, expansion sphincter pharyngoplasty, lateral pharyngoplasty, trans-palatal advancement, and relocation pharyngoplasty) is medically necessary for OSAS in children with neuromuscular disorders who are deemed high-risk for persistent obstruction after adenotonsillectomy alone. (Note: considered experimental/investigational/unproven for otherwise healthy children.); Treatment - Supraglottoplasty is medically necessary for laryngomalacia in members age 2 years or younger with documented hypoxia, hypercapnia, failure to thrive, infantile sleep apnea, cor pulmonale, or pulmonary hypertension that has not resolved with conservative management.. Applies to 20 codes: 95808, 95810, 95811, 95782, 95783, 42820, 42821, 42825, 42826, 42830, 42831, 42835, 42836, 42975, 64582, 64583, 64584, 94660, E0485, E0486.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Experimental, investigational, or unproven (effectiveness not established) - Cautery-assisted palatal stiffening procedure (CAPSO) for the diagnosis and treatment of OSA in children.; Experimental, investigational, or unproven - Chiropractic/osteopathic manipulation for OSA in children.; Experimental, investigational, or unproven - DNA appliance for OSA in children.; Experimental, investigational, or unproven - Flexible positive airway pressure for OSA in children.; Experimental, investigational, or unproven - Injection snoreplasty for OSA in children.; Experimental, investigational, or unproven - Laser-assisted uvuloplasty (LAUP) for OSA in children.; Experimental, investigational, or unproven - Long-range optical coherence tomography of the airway during DISE for OSA in children.; Experimental, investigational, or unproven - Mandibular distraction osteogenesis for OSA in children.; Experimental, investigational, or unproven - Maxillary expander for OSA in children.; Experimental, investigational, or unproven - Maxillary protraction for OSA in children.; Experimental, investigational, or unproven - Measurement of blood leptin levels in OSAS.; Experimental, investigational, or unproven - Measurement of circulating adropin concentrations, plasma pentraxin-3, or TREM-1 levels in OSAS.; Experimental, investigational, or unproven - Measurement of serum interleukin-8 concentrations in OSAS.; Experimental, investigational, or unproven - Midline/partial glossectomy for OSA in children.; Experimental, investigational, or unproven - Montelukast for OSA in children.; Experimental, investigational, or unproven - Nasal surgery for OSA in children.; Experimental, investigational, or unproven - Oral appliances or functional orthopedic appliances for otherwise healthy children (insufficient evidence).; Experimental, investigational, or unproven - Pillar palatal implant system for OSA in children.; Experimental, investigational, or unproven - Pre-fabricated myo-functional appliances (e.g., Myobrace / MyOSA) for OSA in children.; Experimental, investigational, or unproven - Pre-operative tissue doppler echocardiography in children undergoing OSA surgery.; Experimental, investigational, or unproven - Repose system for OSA in children.; Experimental, investigational, or unproven - Respiratory muscle therapy (breathing exercises, oropharyngeal exercises, playing wind instruments) for OSA in children.; Experimental, investigational, or unproven - Somnoplasty for OSA in children.; Experimental, investigational, or unproven - Abbreviated/screening diagnostic techniques, including videotaping, nocturnal pulse oximetry, unattended home PSG, and facility-based daytime abbreviated cardiorespiratory studies (daytime nap PSG, Pap Nap testing) for OSA in children.; Experimental, investigational, or unproven - Epigenetic markers (DNA methylation, histone modifications, non-coding RNAs) for diagnosis/prognosis of OSA in children.; Experimental, investigational, or unproven - Surface electromyography (EMG) for evaluation of OSA in children.; Experimental, investigational, or unproven - Uvulectomy for OSA in children.; Experimental, investigational, or unproven - Palatopharyngoplasty for the treatment of OSAS in otherwise healthy children.; Not covered - Expenses associated with orthodontic treatments (such as rapid maxillary expansion) are considered dental in nature and are not covered under Aetna's medical plans. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0752 — Obstructive Sleep Apnea in Children

Coverage criteria

  • Diagnosis - Nocturnal polysomnography (NPSG) is medically necessary for children and adolescents younger than 18 years, performed in a healthcare facility, for ANY ONE of the following indications: diagnosing OSAS and differentiating it from primary snoring; OR evaluating hypersomnia; OR suspected narcolepsy (in conjunction with MSLT); OR suspected parasomnia; OR suspected restless leg syndrome; OR suspected periodic limb movement disorder; OR suspected congenital central alveolar hypoventilation syndrome; OR suspected sleep-related hypoventilation due to neuromuscular disorders or chest wall deformities.
  • Diagnosis - NPSG after adenotonsillectomy or other pharyngeal surgery for OSAS is medically necessary when ANY ONE of the following is present: age younger than 3 years; OR cardiac complications of OSAS (e.g., right ventricular hypertrophy); OR craniofacial anomalies obstructing the upper airway; OR failure to thrive; OR neuromuscular disorders (e.g., Down syndrome, Prader-Willi syndrome, myelomeningocele); OR obesity; OR prematurity; OR recent respiratory infection; OR severe OSAS on pre-operative PSG (RDI greater than or equal to 19); OR OSAS symptoms persist after treatment. The post-operative study should be delayed 6 to 8 weeks after surgery.
  • Diagnosis - Drug-induced sleep endoscopy (DISE) is medically necessary for surgical planning in children up to age 18 years who have persistent documented OSAS that is refractory to non-invasive therapy and who are eligible for surgery.
  • Treatment - Hypoglossal nerve neuro-stimulation (e.g., Inspire II / Inspire 3028 Upper Airway Stimulation system) is medically necessary for adolescents with Down syndrome when ALL of the following criteria are met: age 13 to 18 years; AND AHI greater than 10 and less than 50; AND absence of complete concentric collapse at the soft palate level; AND the member is contraindicated for or not effectively treated by adenotonsillectomy; AND the member has failed or is intolerant of PAP therapy despite attempts at compliance; AND the member has followed the standard of care with consideration of alternative or adjunct therapies.
  • Treatment - Treatment for OSAS in children with habitual snoring is indicated when the apnea index is greater than 1 on NPSG; the following treatment modalities are addressed below.
  • Treatment - Adenoidectomy and/or tonsillectomy is medically necessary for treatment of OSAS in children with habitual snoring (apnea index greater than 1 on NPSG); Aetna notes that the majority of children benefit from this procedure.
  • Treatment - Continuous positive airway pressure (CPAP) is medically necessary for treatment of OSAS in children with habitual snoring when ANY ONE of the following applies: adenoidectomy/tonsillectomy is contraindicated; OR adenoidectomy/tonsillectomy is delayed; OR adenoidectomy/tonsillectomy was unsuccessful. CPAP is also medically necessary for tracheomalacia.
  • Treatment - Lingual tonsillectomy and/or tongue base reduction is medically necessary to treat tongue base collapse in children with persistent OSA after adenotonsillectomy (e.g., children with obesity, Down syndrome, or craniofacial/neuromuscular disorders).
  • Treatment - Oral appliances or functional orthopedic appliances are medically necessary for children with craniofacial anomalies who show signs and symptoms of OSAS. (Note: considered experimental/investigational/unproven for otherwise healthy children.)
  • Treatment - Palatopharyngoplasty (including UPPP/uvulopalatopharyngoplasty, uvulo-pharyngoplasty, uvulo-palatal flap, expansion sphincter pharyngoplasty, lateral pharyngoplasty, trans-palatal advancement, and relocation pharyngoplasty) is medically necessary for OSAS in children with neuromuscular disorders who are deemed high-risk for persistent obstruction after adenotonsillectomy alone. (Note: considered experimental/investigational/unproven for otherwise healthy children.)
  • Treatment - Supraglottoplasty is medically necessary for laryngomalacia in members age 2 years or younger with documented hypoxia, hypercapnia, failure to thrive, infantile sleep apnea, cor pulmonale, or pulmonary hypertension that has not resolved with conservative management.

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Obstructive Sleep Apnea in Children (CPT 95808), and what gets it denied?
Aetna CPB 0752 covers diagnosis and treatment of obstructive sleep apnea (OSAS) in children under 18. Facility-based nocturnal polysomnography is covered for diagnosis and for specified high-risk post-surgical reassessment, and covered treatments include adenotonsillectomy, CPAP, lingual tonsillectomy/tongue-base reduction, oral appliances for craniofacial anomalies, palatopharyngoplasty in neuromuscular cases, supraglottoplasty for laryngomalacia, and hypoglossal nerve stimulation for adolescents with Down syndrome who meet strict AHI and PAP-failure criteria. The key gate is documented OSAS (e.g., apnea index greater than 1 on polysomnography) with the appropriate clinical indication; many screening tools, drug therapies, biomarkers, and surgical/orthodontic procedures are deemed experimental or not covered as dental. Coverage criteria include: Diagnosis - Nocturnal polysomnography (NPSG) is medically necessary for children and adolescents younger than 18 years, performed in a healthcare facility, for ANY ONE of the following indications: diagnosing OSAS and differentiating it from primary snoring; OR evaluating hypersomnia; OR suspected narcolepsy (in conjunction with MSLT); OR suspected parasomnia; OR suspected restless leg syndrome; OR suspected periodic limb movement disorder; OR suspected congenital central alveolar hypoventilation syndrome; OR suspected sleep-related hypoventilation due to neuromuscular disorders or chest wall deformities.; Diagnosis - NPSG after adenotonsillectomy or other pharyngeal surgery for OSAS is medically necessary when ANY ONE of the following is present: age younger than 3 years; OR cardiac complications of OSAS (e.g., right ventricular hypertrophy); OR craniofacial anomalies obstructing the upper airway; OR failure to thrive; OR neuromuscular disorders (e.g., Down syndrome, Prader-Willi syndrome, myelomeningocele); OR obesity; OR prematurity; OR recent respiratory infection; OR severe OSAS on pre-operative PSG (RDI greater than or equal to 19); OR OSAS symptoms persist after treatment. The post-operative study should be delayed 6 to 8 weeks after surgery.; Diagnosis - Drug-induced sleep endoscopy (DISE) is medically necessary for surgical planning in children up to age 18 years who have persistent documented OSAS that is refractory to non-invasive therapy and who are eligible for surgery.; Treatment - Hypoglossal nerve neuro-stimulation (e.g., Inspire II / Inspire 3028 Upper Airway Stimulation system) is medically necessary for adolescents with Down syndrome when ALL of the following criteria are met: age 13 to 18 years; AND AHI greater than 10 and less than 50; AND absence of complete concentric collapse at the soft palate level; AND the member is contraindicated for or not effectively treated by adenotonsillectomy; AND the member has failed or is intolerant of PAP therapy despite attempts at compliance; AND the member has followed the standard of care with consideration of alternative or adjunct therapies.; Treatment - Treatment for OSAS in children with habitual snoring is indicated when the apnea index is greater than 1 on NPSG; the following treatment modalities are addressed below.; Treatment - Adenoidectomy and/or tonsillectomy is medically necessary for treatment of OSAS in children with habitual snoring (apnea index greater than 1 on NPSG); Aetna notes that the majority of children benefit from this procedure.; Treatment - Continuous positive airway pressure (CPAP) is medically necessary for treatment of OSAS in children with habitual snoring when ANY ONE of the following applies: adenoidectomy/tonsillectomy is contraindicated; OR adenoidectomy/tonsillectomy is delayed; OR adenoidectomy/tonsillectomy was unsuccessful. CPAP is also medically necessary for tracheomalacia.; Treatment - Lingual tonsillectomy and/or tongue base reduction is medically necessary to treat tongue base collapse in children with persistent OSA after adenotonsillectomy (e.g., children with obesity, Down syndrome, or craniofacial/neuromuscular disorders).; Treatment - Oral appliances or functional orthopedic appliances are medically necessary for children with craniofacial anomalies who show signs and symptoms of OSAS. (Note: considered experimental/investigational/unproven for otherwise healthy children.); Treatment - Palatopharyngoplasty (including UPPP/uvulopalatopharyngoplasty, uvulo-pharyngoplasty, uvulo-palatal flap, expansion sphincter pharyngoplasty, lateral pharyngoplasty, trans-palatal advancement, and relocation pharyngoplasty) is medically necessary for OSAS in children with neuromuscular disorders who are deemed high-risk for persistent obstruction after adenotonsillectomy alone. (Note: considered experimental/investigational/unproven for otherwise healthy children.); Treatment - Supraglottoplasty is medically necessary for laryngomalacia in members age 2 years or younger with documented hypoxia, hypercapnia, failure to thrive, infantile sleep apnea, cor pulmonale, or pulmonary hypertension that has not resolved with conservative management.. Applies to 20 codes: 95808, 95810, 95811, 95782, 95783, 42820, 42821, 42825, 42826, 42830, 42831, 42835, 42836, 42975, 64582, 64583, 64584, 94660, E0485, E0486. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Experimental, investigational, or unproven (effectiveness not established) - Cautery-assisted palatal stiffening procedure (CAPSO) for the diagnosis and treatment of OSA in children.; Experimental, investigational, or unproven - Chiropractic/osteopathic manipulation for OSA in children.; Experimental, investigational, or unproven - DNA appliance for OSA in children.; Experimental, investigational, or unproven - Flexible positive airway pressure for OSA in children.; Experimental, investigational, or unproven - Injection snoreplasty for OSA in children.; Experimental, investigational, or unproven - Laser-assisted uvuloplasty (LAUP) for OSA in children.; Experimental, investigational, or unproven - Long-range optical coherence tomography of the airway during DISE for OSA in children.; Experimental, investigational, or unproven - Mandibular distraction osteogenesis for OSA in children.; Experimental, investigational, or unproven - Maxillary expander for OSA in children.; Experimental, investigational, or unproven - Maxillary protraction for OSA in children.; Experimental, investigational, or unproven - Measurement of blood leptin levels in OSAS.; Experimental, investigational, or unproven - Measurement of circulating adropin concentrations, plasma pentraxin-3, or TREM-1 levels in OSAS.; Experimental, investigational, or unproven - Measurement of serum interleukin-8 concentrations in OSAS.; Experimental, investigational, or unproven - Midline/partial glossectomy for OSA in children.; Experimental, investigational, or unproven - Montelukast for OSA in children.; Experimental, investigational, or unproven - Nasal surgery for OSA in children.; Experimental, investigational, or unproven - Oral appliances or functional orthopedic appliances for otherwise healthy children (insufficient evidence).; Experimental, investigational, or unproven - Pillar palatal implant system for OSA in children.; Experimental, investigational, or unproven - Pre-fabricated myo-functional appliances (e.g., Myobrace / MyOSA) for OSA in children.; Experimental, investigational, or unproven - Pre-operative tissue doppler echocardiography in children undergoing OSA surgery.; Experimental, investigational, or unproven - Repose system for OSA in children.; Experimental, investigational, or unproven - Respiratory muscle therapy (breathing exercises, oropharyngeal exercises, playing wind instruments) for OSA in children.; Experimental, investigational, or unproven - Somnoplasty for OSA in children.; Experimental, investigational, or unproven - Abbreviated/screening diagnostic techniques, including videotaping, nocturnal pulse oximetry, unattended home PSG, and facility-based daytime abbreviated cardiorespiratory studies (daytime nap PSG, Pap Nap testing) for OSA in children.; Experimental, investigational, or unproven - Epigenetic markers (DNA methylation, histone modifications, non-coding RNAs) for diagnosis/prognosis of OSA in children.; Experimental, investigational, or unproven - Surface electromyography (EMG) for evaluation of OSA in children.; Experimental, investigational, or unproven - Uvulectomy for OSA in children.; Experimental, investigational, or unproven - Palatopharyngoplasty for the treatment of OSAS in otherwise healthy children.; Not covered - Expenses associated with orthodontic treatments (such as rapid maxillary expansion) are considered dental in nature and are not covered under Aetna's medical plans. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Obstructive Sleep Apnea in Children?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Obstructive Sleep Apnea in Children?
Policy exclusions and limitations: Experimental, investigational, or unproven (effectiveness not established) - Cautery-assisted palatal stiffening procedure (CAPSO) for the diagnosis and treatment of OSA in children.; Experimental, investigational, or unproven - Chiropractic/osteopathic manipulation for OSA in children.; Experimental, investigational, or unproven - DNA appliance for OSA in children.; Experimental, investigational, or unproven - Flexible positive airway pressure for OSA in children.; Experimental, investigational, or unproven - Injection snoreplasty for OSA in children.; Experimental, investigational, or unproven - Laser-assisted uvuloplasty (LAUP) for OSA in children.; Experimental, investigational, or unproven - Long-range optical coherence tomography of the airway during DISE for OSA in children.; Experimental, investigational, or unproven - Mandibular distraction osteogenesis for OSA in children.; Experimental, investigational, or unproven - Maxillary expander for OSA in children.; Experimental, investigational, or unproven - Maxillary protraction for OSA in children.; Experimental, investigational, or unproven - Measurement of blood leptin levels in OSAS.; Experimental, investigational, or unproven - Measurement of circulating adropin concentrations, plasma pentraxin-3, or TREM-1 levels in OSAS.; Experimental, investigational, or unproven - Measurement of serum interleukin-8 concentrations in OSAS.; Experimental, investigational, or unproven - Midline/partial glossectomy for OSA in children.; Experimental, investigational, or unproven - Montelukast for OSA in children.; Experimental, investigational, or unproven - Nasal surgery for OSA in children.; Experimental, investigational, or unproven - Oral appliances or functional orthopedic appliances for otherwise healthy children (insufficient evidence).; Experimental, investigational, or unproven - Pillar palatal implant system for OSA in children.; Experimental, investigational, or unproven - Pre-fabricated myo-functional appliances (e.g., Myobrace / MyOSA) for OSA in children.; Experimental, investigational, or unproven - Pre-operative tissue doppler echocardiography in children undergoing OSA surgery.; Experimental, investigational, or unproven - Repose system for OSA in children.; Experimental, investigational, or unproven - Respiratory muscle therapy (breathing exercises, oropharyngeal exercises, playing wind instruments) for OSA in children.; Experimental, investigational, or unproven - Somnoplasty for OSA in children.; Experimental, investigational, or unproven - Abbreviated/screening diagnostic techniques, including videotaping, nocturnal pulse oximetry, unattended home PSG, and facility-based daytime abbreviated cardiorespiratory studies (daytime nap PSG, Pap Nap testing) for OSA in children.; Experimental, investigational, or unproven - Epigenetic markers (DNA methylation, histone modifications, non-coding RNAs) for diagnosis/prognosis of OSA in children.; Experimental, investigational, or unproven - Surface electromyography (EMG) for evaluation of OSA in children.; Experimental, investigational, or unproven - Uvulectomy for OSA in children.; Experimental, investigational, or unproven - Palatopharyngoplasty for the treatment of OSAS in otherwise healthy children.; Not covered - Expenses associated with orthodontic treatments (such as rapid maxillary expansion) are considered dental in nature and are not covered under Aetna's medical plans. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0752 — Obstructive Sleep Apnea in Children

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0752 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.