BlueCross BlueShield of Tennessee Medical Policy Manual

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:

• Orthognathic Surgery

• Radiofrequency Tissue Volume Reduction (RFTVR) for the Treatment of Upper Airway Obstruction

• Sleep Disorder Diagnosis and Treatment

• Uvulopalatopharyngoplasty (UPPP)/Palatopharyngoplasty (PPP)

IMPORTANT REMINDERS

• Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.

• We develop Medical Policies to provide guidance to Members and Providers.  This Medical Policy relates only to the services or supplies described in it.  The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy.  For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed.  If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.

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

Aurora, R., Casey, K., Kristo, D., Auerbach, S., Bista, S., Chowduri, S.,et al. (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep, 33 (100, 1408-1413.  

BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2011). Surgical treatment of snoring and obstructive sleep apnea syndrome. (7.01.101). Retrieved October 21, 2011 from BlueWeb. (21 articles and/or guidelines reviewed)

Epstein, L., Kristo, D., Strollo, P., Friedman, N., Malhotra, A., Patil, S. et al. (2009). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of Clinical Sleep Medicine, 5 (3), 263-276.

Goode, R. L. (2007). Success and failure in treatment of sleep apnea patients. Otolaryngologic Clinics of North America, 40 (4), 891-901.

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)

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:  12/8/2011

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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.

This document has been classified as public information.