Yes, the American Dental Association (ADA) released a dental code for sleep apnea appliances as of January 2022. The code is Current Dental Terminology (CDT) D9947 for Custom sleep appliance fabrication and placement. 

Will dental insurance pay for a sleep apnea appliance with this new code?  

 

Although it is always exciting to get new codes, we have not yet seen dental plans provide coverage for sleep apnea appliances. Most medical carriers do reimburse for oral appliances for OSA, so we recommend that dental practices continue to bill the patient’s medical insurance for oral appliances for OSA.  

 

Why was a dental code added if sleep apnea appliances are more likely to be covered under medical plans? 

 

According to CDT, the dental code for sleep apnea appliances is for “documentation” purposes. Having a specific code enables offices to cross-code from dental to medical and for recordkeeping. You may have heard the adage, “just because a code exists for a procedure does not guarantee payment by insurance plans.” This adage applies to the new sleep apnea appliance codes. We all wish the dental insurance would immediately reimburse for new codes and technology, but sometimes it takes time for new codes to be integrated into the insurance process. That can always change! In the meantime, medical billing is the best option for sleep appliances.  

 

How do we bill to get the best reimbursement for the patient? 

Sleep Apnea Appliances

With the proper documentation of medical necessity, such as the sleep study, clinical notes, and a prescription from a physician, medical plans frequently cover oral appliances for obstructive sleep apnea. Be sure to implement questionnaires and exam forms specific to obstructive sleep apnea oral appliance therapy to document the symptoms and exam findings needed to show the medical necessity. 

 

Were any other dental codes added for sleep apnea appliances?  

 

In addition to the sleep appliance code, the ADA added other codes for adjustment and repair: 

D9947 Custom sleep appliance fabrication and placement 

D9948 Adjustment of custom sleep apnea appliance  

D9949 Repair of custom sleep apnea appliance 

 

Can you please provide the medical code for oral appliances for Obstructive Sleep Apnea? 

Yes, the following medical code is a HCPCS code, a category of Current Procedural Terminology (CPT):  

E0486 Device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment.

 

We have a patient eager for us to bill their insurance for their sleep apnea appliance. With the new plethora of codes, it can be somewhat confusing. What recommendations do you have to start billing sleep apnea appliances in the dental office?  

 

This article on medical billing for oral appliances is a great starting place: Bill Medical Insurance for Dental Sleep Apnea Appliances – Nierman Practice Management (niermanpm.com) Also, Nierman Practice Management has excellent solutions and education options for medical billing in the dental office and we are here to help. 

 

Any other information to get us started? 

 

It is essential to know that most insurance companies have preauthorization requirements for oral appliances for OSA. Start with the patient’s medical card and perform a phone verification of medical insurance benefits before fabricating an oral appliance. 

Once you know the insurance guidelines, you can provide the best care and reimbursement service for your patients suffering from the debilitating disease of OSA. It is rewarding to help save lives and relationships with oral appliance therapy for OSA. The icing on the cake is maximizing insurance benefits so that the patient can move forward with treatment. 

It is crucial for dental offices to establish the workflow necessary to get paid by medical to help implement oral appliance therapy in your dental office. If you have run into obstacles with medical billing for sleep apnea appliances or would like to learn more, contact NPM at 800-879-6468 or www.NiermanPM.com.  

Article by: Rose Nierman

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