Great news! Most medical insurance plans reimburse for dental practices for oral appliance therapy for obstructive sleep apnea (OSA).  Since there are no specific dental codes available for oral appliances, dental offices must learn how to bill medical insurance for sleep apnea appliances.

For those dental practices billing medical insurance for oral appliances, here are answers to a couple of common questions.

Can you bill medical for sleep apnea appliances that are sold on the internet?

No, and for good reason; to ensure appliances are “necessary treatment” and effective in managing sleep apnea, medical insurance plans only pay for custom-made mouthpieces from qualified dentists.

Do I need documentation for medical insurance for sleep apnea appliances?

Getting paid by medical insurance for sleep apnea appliance requires good records that document all symptoms the patients has suffered because of obstructive sleep apnea. The best format f

or dentists to submit documentation to medical is the standard SOAP note which lists:

  • Subjective complaints
  • Objective findings
  • Assessment
  • Plan

When you bill medical for sleep apnea appliances SUBJECTIVE complaints include chief complaints relating to obstructive sleep apnea including:

  • Excessive daytime sleepiness or insomnia
  • Hypertension or heart disease
  • Cognitive or mood disorders
  • Documentation of CPAP refusal or intolerance.

Can you Bill a Panorex to Medical Insurance?

Radiographs such as a panorex taken during a dental sleep apnea screening can be billed to medical insurance (CPT code 70355) along with an office visit.

When you Bill Medical for Sleep Apnea Appliances, is there a Specific Billing Code?

The medical billing code or sleep apnea, E0486, should be submitted for custom oral appliances.

Pro tip: The appliance is billed on the date of delivery, as opposed to the impression date.

Diagnosis, diagnosis, diagnosis

Just as you have heard the adage in real estate, “location, location, location,” the key to successful oral appliance therapy and medical insurance reimbursement is “diagnosis, diagnosis, diagnosis.”

According to the International Classification of Disease, the medical diagnosis of OSA is G47.33. This ICD-10 code applies to child or adult OSA and will appear on a sleep study when the patient is diagnosed using an overnight sleep study, with interpretation by a sleep physician.

Pro tip: When billing for a dental device for sleep apnea, send a copy of the sleep study to the medical insurer along with your SOAP notes.

Pro tip: Keep in mind that sleep appliances may require preauthorization. The dental office can perform a benefit check or outsource this billing task to a medical billing company specializing in Medical Billing for Sleep Apnea appliances and other dental office procedures.

Does Medicare Pay for Apnea Oral Appliances?

Yes. If addition to private or commercial insurances, “approved” oral appliances for obstructive sleep apnea are covered by Medicare for dentists who become suppliers of Durable Medical Equipment (DME).

When dentists and their teams provide custom-made oral appliances as an alternative to CPAP, lives change for the better.  And medical insurance may cover!

Do you want to learn more about how to successfully bill medical for sleep apnea appliances? Become a Nierman Practice Management certified cross-coding office through online training or our live and virtual seminar, CrossCoding; Unlocking the Code to Medical Billing in Dentistry. If you’re interested in learning more about dental sleep medicine and appliances, our up-coming interactive livestream, Diving Into Dental Sleep Medicine and Appliances is the perfect course for you.

NiermanPM hosts many 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.

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Article by: Rose Nierman, Founder of Nieman Practice Management since 1988.

Nierman Practice Management helps dental practices bill medical insurance for sleep apnea appliances, TMJ disorders and oral surgeries. Through their EMR software, DentalWriter, and their new online course series, the Complete Cross-Coder, Nierman Practice Management has all the solutions you need to implement medical billing in your dental practice.

For more information, call 1-800-879-6468 or view the medical billing course schedule.

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