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Medicare Oks Oral Appliance Reimbursement for Sleep Apnea
Medicare has approved reimbursement for oral appliances to treat sleep apnea, according to HME News:
The four DME MACS stated in November that custom oral appliances used to treat sleep apnea (E0486) would be covered if certain criteria are met. Those criteria include a face-to-face evaluation with the treating physician; an inability to tolerate a PAP device; and provision and billing by a dentist. The policy is effective for claims on or after Jan. 3, 2011.
Views: 1750
Replies to This Discussion
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Permalink Reply by Mary Z on
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This should help a lot of people who can't tolerate CPAP. Does privat insurance usually follow suit, or does this help only those of us on Medicare?
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Permalink Reply by George Sibley on
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I called Medicare on 02/21/2011 to ask questions about coverage for oral appliances. The agent said oral appliances for sleep apnea are not covered. She transferred me to the durable medical equipment, and this agent said the same thing.
Is there any reference I can give Medicare agents so prove they are covered if certain criteria are met?
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There are many FDA approved oral appliances used for sleep apena, and I am trying to decide on one. Does anyone who tried the Hilsen Oral Appliance have any comments or suggestions?
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I found the billing code for oral appliances, E0486, called Medicare again, and the agent said they are covered and that I do not have to re-take a sleep study even though mine was 2 years ago.
Looking good!
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