Laser Assisted Uvulopalatoplasty (LAUP)
DESCRIPTION
Laser-assisted uvulopalatoplasty (LAUP) uses a carbon dioxide (CO2) laser to sequentially reshape superficial palatal tissues in an attempt to create a permanent, non-collapsing oropharyngeal airway. The extent of the surgery is typically different than the standard uvulopalatopharyngoplasty (UPPP), since only part of the uvula and associated soft-palate tissues are reshaped.
LAUP is an outpatient alternative that has been promoted as a treatment of snoring with or without associated obstructive sleep apnea (OSA). The procedure as initially described does not remove or alter tonsils or lateral pharyngeal wall tissues, although additional surgery may be performed, such as tonsillectomy or septoplasty. With the LAUP, the individual undergoes from three to seven sessions of surgery at three- to four-week intervals. One purported advantage of LAUP is that the amount of tissue ablated can be titrated such that the treatment can be discontinued once snoring is eliminated.
POLICY
Laser-assisted uvulopalatoplasty for the treatment of obstructive sleep apnea syndrome is considered investigational.
Laser-assisted uvulopalatoplasty for the treatment of socially disruptive snoring alone is considered not medically necessary.
See also:
ADDITIONAL INFORMATION
The LAUP cannot be considered an equivalent procedure to the standard UPPP, with the laser simply representing a surgical tool that the physician may opt to use. LAUP is considered a unique procedure, raising unique issues of safety and particularly effectiveness.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2007). Minimally invasive surgery for snoring, obstructive sleep apnea syndrome/upper airway resistance syndrome (7.01.101). Retrieved January 21, 2009 from BlueWeb. (21 articles and/or guidelines reviewed)
Goode, R. L. (2007). Success and failure in treatment of sleep apnea patients. Otolaryngologic Clinics of North America, 40 (4), 891-901.
Han, S., & Kern, R. C. (2004). Laser-assisted uvulopalatoplasty in the management of snoring and obstructive sleep apnea syndrome. Minerva Medica, 95 (4), 337-345.
Hayes. Medical Technology Directory. (2005, September). Sleep apnea treatment, surgical. Retrieved January 21, 2009 from www.Hayesinc.com/subscribers. (77 articles and/or guidelines reviewed)
Larrosa, F., Hernandez, L., Morello, A., Ballester, E., Quinto, L., & Montserrat, J. M. (2004). Laser-assisted uvulopalatoplasty for snoring: Does it meet the expectations? European Respiratory Journal, 24 (1), 66-70. (Level 3 Evidence - Industry sponsored)
Littner, M., Kushida, C. A., Hartse, K., Anderson, W. M., Davila, D., Johnson, S. F., et al. (2001). Practice parameters for the use of laser-assisted uvulopalatoplasty: An update for 2000. Sleep, 24 (5), 603-619.
Riverbend: Government Benefits Administrator. Local Coverage Determinations (LCDs). (August, 2008). LCD for laser assisted uvulopalatoplasty (LAUP) (L1264). Retrieved January 21, 2009 from http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=1264&lcd_version=19&show=all.
Sundaram S, Bridgman SA, Lim J, Lasserson TJ. Surgery for obstructive sleep apnoea. The Cochrane Database of Systematic Reviews 2005, Issue 4.Art. No.:CD001004.pub2. DOI: 10.1002/14651858.CD001004.pub2. (Level 2 Evidence - Independent study)
ORIGINAL EFFECTIVE DATE: 3/1985
MOST RECENT REVIEW DATE: 3/12/2009
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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