Laser Assisted Uvulopalatoplasty (LAUP)
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.
Laser-assisted uvulopalatoplasty (LAUP) for the treatment of obstructive sleep apnea syndrome is considered investigational.
Laser-assisted uvulopalatoplasty (LAUP) for the treatment of socially disruptive snoring alone is considered not medically necessary.
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.
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.
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). Position statement: surgical management of obstructive sleep apnea. Retrieved July 21, 2017 from http://www.entnet.org/content/surgical-management-obstructive-sleep-apnea.
BlueCross BlueShield Association. Evidence Positioning System. (1:2019). Surgical treatment of snoring and obstructive sleep apnea syndrome. (7.01.101). Retrieved April 30, 2019 from https://www.evidencepositioningsystem/. (28 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)
ORIGINAL EFFECTIVE DATE: 3/1985
MOST RECENT REVIEW DATE: 5/9/2019
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.