IMPORTANT: Reimbursement Limited to Two Appliances by Medicare's New Guidelines

Important Information For DentalWriter Clients who are Durable Medical Equipment (DME) Suppliers for Medicare

Medicare Approved Devices for Reimbursement are Currently Limited to Two Appliances!
Medicare’s Pricing, Data, Analysis and Coding Contractor (PDAC) has recently gone through a recertification process for the code E0486. A new description for oral appliances and criteria for E0486 was provided to the PDAC by the DMERC Medical Directors and CMS last July and a review process was set in place.

COVERED: All of the current appliances have now been reviewed for PDAC and only two (2) appliances are currently officially approved for Medicare reimbursement:
• UCLA Modified Herbst (Space Maintainers Laboratory)
• Herbst Sleep Appliance (Gergen’s Ortho Lab)


NOT COVERED: Appliances with Effective End Dates: [b]The PDAC has specified Effective End Dates for many of the devices, including but not limited to: TAP, SomnoDent, Dorsal, Herbst from Great Lakes, Klearway, TAP and SUAD. Appliances that do not meet the new guidelines (below) should billed as A9720: Noncovered Item or Service. This current review process is planned until November of 2012 and some companies are appealing.
How do you know if appliances have changed?

To view the list of appliances on a regular basis use this link: https://www.dmepdac.com/dmecsapp/do/search Scroll down to Search DME Product Classification List and enter E0486 as the HCPCS and click Go.

Practices billing Medicare should check the list on a regular basis.

Here is the link to the recently released Correct Coding for Oral Appliance Therapy for Obstructive Sleep Apnea:

https://www.dmepdac.com/...icles/2012/07_12_12.html