Hi Courtney and others,
I am currently working on our first patient with the new Tricare/Humana Military. They are interested in E0486.

In the past (when Tricare was still through HealthNet Federal Services), I was told that since Medicare does not have a fee published for E0486, the claim would be paid based on "State Prevailing Rates" which could be looked up on the mytricare.com website (https://www.mytricare.com/internet/tric/tri/mtc_nprov.nsf/PGS/BllngInfrmtn_NrthRgnSttPrvlngRts_1).

Unfortunately, I just spoke to a few different representatives with Humana Military and there is no longer a way to get this information in advance; you must wait until claim is processed.

We are located in Ohio (was Tricare North w/ HNFS, now is Tricare East w/ Humana). The state prevailing rate used to be $3995. Our fee is well under this $3995, but I worry about what if the new rate is less than our fee. I want to provide our patients with as "accurate" of an estimate as possible.

From experience, does anyone know what the new rate for E0486 is for Tricare/Humana Military in the Ohio region?

Thank you,
S

Hi Courtney,
I wanted to check in and see if anything has changed since may...have you have recently received any recent Humana Military EOBs from the East region for E0486 showing their allowed amount? I know a couple months ago you mentioned claims being processed with an allowed amount of 2000-3000...but I recently saw another person on this forum mention that Humana is only paying their office 200-400 for sleep apnea oral appliances. Obviously deductibles and other factors must be taken into consideration, but this still seems really low so I thought it wouldn't hurt to ask! Thank you.