February 2016

Originally published in Healthcare Business Monthly. 

Before reporting treatment, make sure oral appliances are reasonable and necessary, and check carrier policies.

Obstructive sleep apnea (OSA) affects 18 million Americans, according to the National Sleep Foundation. OSA occurs when breathing is interrupted briefly and repeatedly during sleep. There are circumstances under which Medicare will cover oral appliances used for the treatment of OSA using billing code E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment. To ensure correct billing of OSA services, let’s review procedural documentation requirements.*

*This analysis applies specifically to jurisdictions including New York, Connecticut, District of Columbia, Delaware, Massachusetts, Maryland, Maine, New Hampshire, New Jersey, Pennsylvania, Rhode Island, and Vermont. For coverage in other jurisdictions, refer to the appointed Medicare administrative contractor’s guidance.