There are two codes to choose from when coding for oral appliances being used to treat snoring and Obstructive Sleep Apnea (OSA), E0486 and E0485. E0486 is commonly covered by medical insurance for patients who meet criteria.
9940, D-9940, D-9941 Occlusal Appliance for Bruxism. ADA Code: 05899 Unspecified Prosthetic Procedure. Medical Codes. Diagnostic Codes (ICD#): 780.53 Hyper-Somnia with Sleep Apnea. 786.03 Sleep Apnea. 780.57 Sleep Apnea Splint. Procedure Codes:
E0486 Code for Medicare Dental Sleep Medicine Billing. When billing a dental sleep medicine case to Medicare, another modifier is required with the E0486 code. That modifier is KX, which means your documentation for that case is on file. So when billing to Medicare, the full code to use is E0486-KX-NU.
E0486 Code for Medicare Dental Sleep Medicine Billing When billing a dental sleep medicine case to Medicare, another modifier is required with the E0486 code. That modifier is KX, which means your documentation for that case is on file. So when billing to Medicare, the full code to use is E0486-KX-NU.
Medical Code for Custom-Fitted Obstructive Sleep Apnea Appliance. E0486 is the current HCPCS medical code for a custom-fitted mandibular sleep apnea appliance, used for dental sleep medicine medical billing.
If you diagnosed with obstructive sleep apnea, Medicare Part B will cover an oral appliance, which is an alternative to a CPAP machine, or Continuous Positive Airway Pressure. Your doctor must prescribe the appliance.
HCPCS code E0486 describes a custom fabricated oral appliance created from scratch using oral/dental impressions or molds taken from the patient.
Using Code D5999 for Billing Sleep Apnea Device.
SomnoMed Device Costs: Facts About Insurance Coverage for SomnoDent Oral Devices. Oral appliance therapy is virtually always covered by medical insurance and government payers (Medicare, Medicaid, and military) using the same criteria that are used for coverage of continuous positive airway pressure (CPAP) therapy.
A CUSTOM FABRICATED MANDIBULAR ADVANCEMENT ORAL APPLIANCE (E0486) USED TO TREAT OBSTRUCTIVE SLEEP APNEA (OSA) IS COVERED IF CRITERIA A – D ARE MET. A. 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.
D9947 — Custom sleep appliance fabrication and placement.
Sleep Disorders List – ICD-10 Codes and NamesDIAGNOSISCodeApnea, not elsewhere specifiedR06.81Unspecified Sleep ApneaG47.30Circadian Rhythm Sleep Disorders (NOS)G47.20Delayed Sleep Phase TypeG47.2169 more rows
Primary diagnosis code for CPT codes 41512:CodeDescriptionG47.33Obstructive sleep apnea (adult) (pediatric)
ICD-10 Code for Obstructive sleep apnea (adult) (pediatric)- G47. 33- Codify by AAPC. Diseases of the nervous system. Episodic and paroxysmal disorders. Sleep disorders(G47)
Sleep disorder, sleep apnea. Clinical Information. A disorder characterized by cessation of breathing for short periods during sleep. A sleep disorder that is marked by pauses in breathing of 10 seconds or more during sleep, and causes unrestful sleep.
Sleep apnea is a common disorder that can be serious. In sleep apnea, your breathing stops or gets very shallow. Each pause in breathing typically lasts 10 to 20 seconds or more. These pauses can occur 20 to 30 times or more an hour. The most common type is obstructive sleep apnea.
Symptoms include loud or abnormal snoring, daytime sleepiness, irritability, and depression. Cessation of breathing for 10 seconds or more during sleep and consequent oxygen desaturation. Cessation of breathing for short periods during sleep.
The 2022 edition of ICD-10-CM G47.30 became effective on October 1, 2021.
However, not everyone who snores has sleep apnea. When your sleep is interrupted throughout the night, you can be drowsy during the day. People with sleep apnea are at higher risk for car crashes, work-related accidents and other medical problems.
If the AHI or RDI is calculated based on less than 2 hours of sleep or recording time, the total number of recorded events used to calculate the AHI or RDI (respectively) must be at least the number of events that would have been required in a 2-hour period (i.e., must reach > 30 events without symptoms or > 10 events with symptoms). Projections of AHI or RDI based upon shorter testing times and/or fewer events are not acceptable for use in determining eligibility for payment.
The sleep test is conducted by an entity that qualifies as a Medicare provider of sleep tests and is in compliance with all applicable state regulatory requirements.
Coverage of an oral appliance device for the treatment of OSA is limited to claims where the diagnosis of OSA is based upon all of the following:
Coverage of an oral appliance for the treatment of OSA is limited to claims where the diagnosis of OSA is based upon a Medicare-covered sleep test. The sleep test must be either a polysomnogram performed in a facility-based laboratory (Type I study) or an inpatient hospital-based or home-based sleep test (HST) (Types II, III, IV, Other).
Analysis of the Medicare Coverage Database indicates that the A/B MAC contractors have L CDs and Billing and Coding articles that address the coverage, coding and payment rules for diagnostic sleep testing. Furthermore, CMS addresses diagnostic sleep testing device requirements in the CMS National Coverage Determination (NCD) 240.4.1 (CMS Pub. 100-03, Chapter 1, Part 4).
The code most often used for a sleep apnea device is E0486 as long as the device meets certain criteria as below.
Code E0486 may only be used for custom fabricated mandibular advancement devices. To be coded as E0486, custom fabricated mandibular advancement devices must meet all of the criteria below: Have a fixed mechanical hinge (see below) at the sides, front or palate; and,
Recently questions have arisen about reimbursement for custom fabricated oral appliances coded as E0486 (ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR NON-ADJUSTABLE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT). Only oral appliances used for the treatment of obstructive sleep apnea (OAOSA) that meet the durable medical equipment (DME) statutory benefit category requirements are eligible for Medicare reimbursement by the Durable Medical Equipment Medicare Administrative Contractors (DME MACs). All requirements of the definition must be met before an item can be considered to be DME (CMS IOM 100-2, Ch. 15, §100). Oral devices that do not meet the DME benefit criteria are classified as dental appliances and are not eligible for reimbursement under the DME benefit by the DME MACs.
Custom fabricated mandibular advancement devices that do not incorporate all of the criteria above must be coded as A9270.
A custom fabricated oral appliance (E0486) is one which is individually and uniquely made for a specific patient. It involves taking an impression of the patient’s teeth and making a positive model of plaster or equivalent material. Basic materials are used with the positive model to produce the final product. Custom fabrication requires more than trimming, bending, or making other modifications to a substantially prefabricated item. A custom fabricated oral appliance may include a prefabricated component (e.g., the joint mechanism).
D5999 is seldom covered by plans and it is more complicated in documentation than just a narrative.. In order to process the claim correctly you have to have a diagnosis in the form of SOAP notes. Some medical plans that do cover sleep apnea appliance cover certain approved brands only and you have to use ICD-10 diagnostic codes along ...
The ICD-10 diagnosis code for obstructive sleep apnea is G47.33. Keep in mind that this diagnosis MUST come from a sleep physician and that a dentist CANNOT diagnosis obstructive sleep apnea.
Dental sleep medicine practices that are billing obstructive sleep apnea treatment to medical insurance need to have the correct ICD-10 diagnosis code on the claim form when billing the E0486 code.
That modifier is KX, which means your documentation for that case is on file. So when billing to Medicare, the full code to use is E0486-KX-NU. If the documentation requirements have not ...
So when billing to Medicare, the full code to use is E0486-KX-NU. If the documentation requirements have not been met, you should not use the KX modifier. Instead, you will use the EY, GA or GZ modifier depending on the situation.
E0486 is the current HCPCS medical code for a custom-fitted mandibular sleep apnea appliance, used for dental sleep medicine medical billing. The description for E0486 is an oral device/appliance used to reduce upper airway collapsibility. This includes adjustable or non-adjustable, custom fabricated, fitting and adjustment.