Great news! Many medical insurance plans reimburse for oral appliances for obstructive sleep apnea (OSA).

In order to gain reimbursement, the insurer will require a copy of a sleep study with a diagnosis of OSA. They also will request a narrative report from the dentist’s oral exam in the SOAP format.  The SOAP narrative report includes subjective complaints, objective exam findings, assessment (with ICD-10 codes), and the plan.

In order to bill medical for sleep apnea appliances it’s important to convert your dental office to a “medical-model” type practice and implement some of the following:

  1. Insurers require a SOAP report generated from the screening and delivery appointments so it’s essential to implement a system to create your narrative to demonstrate medical necessity.
  2. When a pre-authorization is required for an oral appliance, submit the documentation of medical necessity and await approval prior to delivering the appliance to the patient.
  3. Include the sleep study, a prescription from the treating physician and documentation of CPAP refusal or intolerance.

Dentists who transform their offices into the medical model and a wellness office by becoming a Cross-Coding office and bill medical insurance are helping more patients with the insidious disease of sleep apnea. Nierman Practice Management strives to stay abreast of changes in medical billing for dentists relating to dental sleep medicine, oral surgeries, TMD, CBCT, and other procedures.  We’re happy to help you with any questions and review proven, repeatable strategies that many DSM dentists have applied to be successful.

Do you want to learn more about how to successfully bill medical for sleep apnea appliances? Become a Cross-Coding office and join us at any of our continuing education seminars, CrossCoding; Unlocking the Code to Medical Billing in Dentistry. NPM also hosts CE courses on the clinical treatment of TMJ disorders and Dental Sleep Medicine. For more information, call us at 1-800-879-6468 or view our full course schedule on our website.

Author: Rose Nierman, Founder & CEO, Nierman Practice Management