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Hi, My name is Tina and I work for a dental office and I have been to one of your Medical coding and billing seminars and got a lot of useful information but I had a question needing to be cleared up. I know we have to have a sleep study on file to submit to Medicare but my question is I thought I had heard that the sleep study has to be asked for by a MD not by a General Dentist. In other words the referring physician for the sleep study has to be a medical doctor, is this correct? I know the MD has to refer the patient to us for all medically needed appliances but can we, as a dental office, refer a patient to another MD or sleep doctor for the sleep study? Thanks
Hi Tina! Great question. Yes some state guidelines and/or medical insurers do require that a physician be the one to order the sleep study. For Medicare, for example, the LCD states as one of the coverage criteria for an oral appliance for OSA that: “The beneficiary has a face-to-face clinical evaluation by the treating physician prior to the sleep test to assess the beneficiary for obstructive sleep apnea testing”. So in this instance, it is expected the evaluation physician would determine the need for testing and order the sleep study if necessary. However, yes you can certainly refer the patient to an MD/Sleep Doc after screening! Hope this helps!
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