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.