Aetna considers pharyngeal and lingual tonsillectomy medically necessary as an isolated procedure in adult OSA where hypertrophied tonsils compromise the airway space. A tonsillectomy is also considered medically necessary with UPPP in members who meet medical necessity criteria for UPPP below. An adenoidec...
A.5. Across spending measures, we consistently find a lack of correlation between the cost of a procedure and wait times. This is true even for services with the largest variation in expected costs, such as vaginal deliveries and arthroscopy.25 Taken together with the regression results above,...