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We recently submitted K0739 for an oral appliance repair to BlueCross BlueShield and it was denied. We did have to send the appliance back to the lab that originally constructed it for the repair. The denial messages stated “service not covered by contract for this type of provider”. Any advice on how to appeal or if we are able to appeal? Thank you.
We recently submitted K0739 for an oral appliance repair to BlueCross BlueShield and it was denied. We did have to send the appliance back to the lab that originally constructed it for the repair. The denial messages stated “service not covered by contract for this type of provider”. Any advice on how to appeal or if we are able to appeal? Thank you.
Hi Eastland Dental Center! Well that is certainly an interesting response! (the appliance is covered for this type of provider, but not repairs to it!) 😉 We have had reports from some clients that certain insurers like blue cross blue shield prefer different codes for repairs – even though Medicare and many other insurers state K0739 as the proper code for repairs to custom made oral appliances for OSA. So – you could either appeal this denial stating that K0739 is the code Medicare DME suggests for repairs to custom made oral appliances for OSA and that since E0486 is covered for your provider type, then repairs to it (K0739) should be covered for your provider type as well. Or, you could try a different code. A few practices have reported success with the “L” codes: L4205 – Repair of orthotic device, labor component, per 15 minutes L4210 – Repair of orthotic device, repair or replace minor parts Or, there are the RB and RA modifiers that can be used on E0486 for replacement and replacement of minor parts: RA – Replacement of a DME, Orthotic or Prosthetic Item RB – Replacement of a Part of a DME, Orthotic or Prosthetic Item Furnished as Part of a Repair Hope this helps!
Hi Betty! You got it – K0739 is the best one to use for repair of an oral appliance for OSA 🙂 Medicare DME confirmed this on a recent webinar they held as well.
What is the best code to use to billed Medical Insurance for an E0486 appliance repair that requires the appliance to be returned to the lab? I found this code. HCPCS 2016 Code : K0739 : Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes Thank you, Betty Patient Care Coordinator Everett Dental Solutions for Sleep
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