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Is there anyone out there with medical billing experience in regard to nursing homes and E4806 type devices (NOT CPAP machines). I was told vaguely that prior to 100-180 days in a nursing home a patient would not qualify and even then only in certain LCD's. I am confused and am trying to get the billing down pat before I approach one of the nursing homes / physicians to advise them of this product/service
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
Great question! Although I do not have experience myself billing nursing homes for E0486 - but I would imagine that would be primarily billing with Medicaid (which is managed by state) - does that seem about accurate to you? We do work with some dental practices that have enrolled with their state's Medicaid program for oral appliances for OSA, however in the dental practice setting. So, it will vary from state to state for Medicaid.
Custom made oral appliances through Medicare for OSA do require a DDS/DMD to do the fitting, and a physician to write the Rx for the appliance so that is something good to keep in mind. (so basically, physicians should not be taking impressions for & fitting the oral appliance by most medical policies out there).
Hope this helps and please let me know if you have any further questions!
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