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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101.

The rules say that Covered Indications FDA-approved hypoglossal nerve neurostimulation is considered medically reasonable and necessary for the treatment of moderate to severe obstructive sleep apnea when all of the following criteria are met:

1. Beneficiary is 22 years of age or older; and 
2. Body mass index (BMI) is less than 35 kg/m2; and 
3. A polysomnography (PSG) is performed within 24 months of first consultation for HGNS implant; and 
4. Beneficiary has predominantly obstructive events (defined as central and mixed apneas less than 25% of the total AHI); and 5. AHI is 15 to 65 events per hour; and 
6. Beneficiary has documentation that demonstrates CPAP failure (defined as AHI greater than 15 despite CPAP usage) or CPAP intolerance (defined as less than 4 hours per night, 5 nights per week or the CPAP has been returned) including shared decision making that the patient was intolerant of CPAP despite consultation with a sleep expert; and 
7. Absence of complete concentric collapse at the soft palate level as seen on a drug-induced sleep endoscopy (DISE) procedure; and 
8. No other anatomical findings that would compromise performance of device (e.g., tonsil size 3 or 4 per standardized tonsillar hypertrophy grading scale).

Limitations 
The following are considered not reasonable and necessary and therefore will be denied:

1. Use for all other indications. 
2. Non-FDA-approved hypoglossal nerve neurostimulation. 
3. Presence of any of the following: Beneficiaries with central and mixed apneas that make up more than one-quarter of the total AHI. Beneficiaries with an implantable device could experience unintended interaction with the HGNS implant system. 

Limitations are: 
BMI equal to or greater than 35
Neuromuscular disease affecting the respiratory system 
Hypoglossal-nerve palsy 
Severe restrictive or obstructive pulmonary disease 
Moderate-to-severe pulmonary arterial hypertension 
Severe valvular heart disease 
New York Heart Association class III or IV heart failure 
Recent myocardial infarction or severe cardiac arrhythmias (within the past 6 months) 
Persistent uncontrolled hypertension despite medication use 
An active, serious mental illness that reduces the ability to carry out Activities of Daily Living (ADLs) and would interfere with the patient's ability to operate the HNS and report problems to the attending provider 
Coexisting nonrespiratory sleep disorders that would confound functional sleep assessment 
Beneficiaries who are, or who plan to become pregnant. 
Beneficiaries who require magnetic resonance imaging (MRI) with model 3024. 
Beneficiaries, who require magnetic resonance imaging (MRI) with model 3028, can undergo MRI on the head and extremities if certain conditions and precautions are met. Please refer to the Manufacturer Guidelines for this model and future models for information. 
Beneficiaries who are unable or do not have the necessary assistance to operate the sleep remote. 
Beneficiaries with any condition or procedure that has comprised neurological control of the upper airway.

4. Drug Induced Sleep Endoscopy (DISE): Due to documented inconsistency in determining if complete concentric collapse (CCC) is present, the inserting provider shall be certified by the FDA approved manufacturer's second opinion service of validation via video clip submissions of at least 80% agreement in at least 15 consecutive studies. Inserting providers shall have documentation to submit to this contractor if necessary. 
5. Shared Decision Making (SDM): SDM, by definition, is any documented conversation between an attending provider and the patient, and not between multiple providers. Providers shall provide these documents if requested by the contractor.

You can find this information in Medicare's Local Coverage Determination (LCD): Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (L38387). 

The rules say that One professional society requested Home Sleep Study (HSS) results be allowed for determination of degree of OSA, CPAP effectiveness, etc. The CMS National Coverage Determination (NCD) Sleep Testing for Obstructive Sleep Apnea (OSA) 240.4.1 provides for home sleep studies in some instances. For determining the degree of OSA, e.g., the AHI, the effect of CPAP, and other measurements required for HGN eligibility, the study must be performed in a free-standing or hospital sleep lab facility. All of the HGN UAS studies had the initial sleep study performed in such facilities. A few allowed home studies to determine later follow-up. You can find this information in Medicare's Local Coverage Article: Response to Comments Response to Comments: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (A57967).

If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.