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Hi Guest!
Yes, as long as the physician is not recommending any additional testing, an appliance for primary snoring can certainly be fabricated. However, most medical plans do not offer coverage for custom made appliances (E0486) when the diagnosis is snoring alone or upper airway resistance syndrome (which doens't sounds like an issue in this case).
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If a patient is not utilizing any insurance and tested negative for sleep apnea but still wants a sleep appliance are we able to make her one? if not can we make her a temporary sleep appliance?
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There is an excellent mean which simply rescues from snoring and allows well to sleep, zyppah http://aboutzyppah.com/ I a long ago use them and he well helps to avoid noise and quietly to sleep.
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Hi Robin!
No problem :) Here are the current day amounts for CPT 95800 for Medicare Part B for maryland (Novitas, Jurisdiction L) for the baltimore & surrounding counties locality:
Participating: 196.23
Non-participating: 186.42
Limiting charge: 214.38
Of course keep in mind, Medicare tends to be on the lower average fee range.....
Hope this helps, and please let us know if you have any further questions!
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Thank
you and yes please send me the fee information for Maryland!
Robin
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Hi SbrushDDS!
Great questions:
1) I see that the CPT code for titration may be 95810? Or as it seems above you should use 95800?
95810 stands for: (Polysomnography; sleep staging with four or more additional parameters of sleep, attended by a technologist)
So this would only be used for an in-lab attended study.
95800 stands for: sleep study, unattended, simultaneous recording: heart rate, oxygen saturation,
respiratory analysis (eg, by airflow or peripheral arterial tone) and sleep time.
So for an HST, as long as the unit you are using meets the description of 95800 above, that would be the most appropriate code. Other HST codes are 95801 and 95806.
2) Would the fee for a titration be the same as a study?
Usually yes as long as the study is being interpreted by a sleep physician on both instances.
3) Where can one go to find the average fees for your geographic area?
The Medicare fee schedule is a publicly accessible fee schedule, so that is usually a good resource. I would be happy to send you the information for your area if you would like! (i believe you are in Maryland?)
And finally, yes you can receive e-mail notification :) You can either click the checkbox when you are making a post, found right above the "post" button that says "watch this topic and receive notification of activity via e-mail". Or, you can watch entire threads by choosing the "watch forum" link in the lower right hand corner of any of the threads in the DW forums.
Hope this helps, please feel free to contact us with any further questions!
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I know this may be redundant but I found the responses below unclear regarding the billing insurance for a post oral appliance delivery titration using a HST (in particular ours is a WATCHPat. We do a titration 12-months post delivery.
I have a two part question:
1) I see that the CPT code for titration may be 95810? Or as it seems above you should use 95800?
2) Would the fee for a titration be the same as a study?
3) Where can one go to find the average fees for your geographic area?
Thank you for your response.
PS as a new poster - do I receive notifications of a response or do I just have to keep checking back on this particular forum?
Robin Coblyn
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Hi kanehldental!
Great questions.
Q1 - What is the code for the Embletta Gold? 01 or 06?
There are three CPT codes commonly used to code for home sleep testing -
95800 - sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory analysis (e.g. by airflow or peripheral arterial tone), and sleep time
95801 - sleep study, unattended, simultaneous recording; minimum of, heart rate, oxygen saturation,
respiratory analysis (e.g. by airflow or peripheral arterial tone)
95806 - sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg. Thoracoabdominal movement)
Below is a graph provided by Embla on their website of the channels recorded by the Embletta Gold:
Q2 - As a dental office can we charge insurance for the first test (as in not formerly diagnosed with OSA)? Previously the answer was no (I'm not sure why), but the above question/answer makes me think we can.
Great question - the answer to this one is that is will depend on your state board's position on whether or not it is within a DDS/DMD's scope of practice or not to administer a home sleep test, and whether or not the patient's insurance company requires than an MD/DO be the rendering provider for sleep testing or not.
Hope this helps!
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