BlueCross BlueShield of Tennessee Medical Policy Manual

Laser Assisted Uvulopalatoplasty (LAUP)

DESCRIPTION

Laser-assisted uvulopalatoplasty (LAUP) is an outpatient procedure proposed as a treatment for snoring with or without associated obstructive sleep apnea. The procedure sequentially reshapes superficial palatal tissue using a carbon dioxide laser. LAUP differs from standard uvulopalatopharyngoplasty (UPPP) since only part of the uvula and associated soft-palate tissues are reshaped. LAUP does not remove or alter tonsils or lateral pharyngeal wall tissue. LAUP is performed in 3 – 7 sessions at 3 - 4 week intervals. One purported advantage of LAUP is that the amount of tissue ablated can be titrated so treatment can be discontinued once snoring is eliminated.

LAUP cannot be considered an equivalent procedure to UPPP.  LAUP also differs from radiofrequency ablation of the soft palate although the concept is similar.

POLICY

See also:

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Minimally invasive surgical procedures such as LAUP have limited efficacy in individuals with mild-to-moderate OSA and have not been shown to improve excessive daytime sleepiness in adults. Additional studies are needed.

SOURCES

American Academy of Otolaryngology – Head and Neck Surgery. (2014). Position statement: surgical management of obstructive sleep apnea. Retrieved July 21, 2017 from http://www.entnet.org/content/surgical-management-obstructive-sleep-apnea.

American Academy of Sleep Medicine (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults.  Retrieved July 21, 2017 from http://www.aasmnet.org/Resources/PracticeParameters/PP_SurgicalModificationsOSA.pdf.

BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2016). Surgical treatment of snoring and obstructive sleep apnea syndrome. (7.01.101). Retrieved July 21, 2017 from BlueWeb. (31 articles and/or guidelines reviewed)

Camacho, M., Nesbitt, B., Lambert, E., Song, S., Chang, E., Liu, S., et al. (2017). Laser-assisted uvulopalatoplasty for obstructive sleep apnea: a systematic review and meta-analysis. Sleep, 40 (3), 1-8. (Level 1 evidence)

Göktas,Ö., Solmaz, M., Göktas, G., & Olze, H. (2014). Long-term results in obstructive sleep apnea syndrome (OSAS) after laser-assisted uvulopalatoplasty (LAUP). PLOS One, 9 (6), e100211. (Level 4 evidence)

Wisconsin Physician Services Insurance Corporation (2017, January) Local Coverage Determination (LCD) for surgical treatment of obstructive sleep apnea (OSA) (L34526). Retrieved July 21, 2017 from https://www.cms.gov.

ORIGINAL EFFECTIVE DATE:  3/1985

MOST RECENT REVIEW DATE:  8/10/2017

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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