Rank: New Member
Joined: 5/17/2017(UTC)
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Can we bill medicare for the consult/eval management codes(99213), CT Scan(70486),office visits or any other codes pertaining to either E0486 or A9720. If medicare won't pay for A9720 will they pay for any of the other codes if we bill out A9720?
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi drlmdds!
Great question. We do not recommend billing Medicare Part B for office visits and xray pertaining to E0486, as there is language in Medicare policy that states any imaging and radiographs needed in order to fabricate the appliance is considered included in E0486.
We do work with some practices who have chosen to enroll as a Medicare Part B provider for their Part B jurisdiction and bill out those initial office visits and x-rays, we just do not recommend it :)
Hope this helps!
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Rank: Guest
Joined: 9/8/2012(UTC)
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Is this still the case that Medicare considers E0486 all inclusive and you cannot bill for office visit/eval 99213? Thank you.
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Rank: Administration
Joined: 11/21/2012(UTC)
Posts: 1,611
Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
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Hi Guest!
Yes, Medicare DME still considers E0486 all inclusive, they have stated that dentists should not bill E&M codes related to sleep appliances. They have stated in a document distributed at the most recent AADSM meeting that "oral surgeons can bill E&M (99202-99205), in a limited fashion, when evaluating patients for sleep apnea to determine their suitability for placement of an oral device".
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