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I was just asked the question whether an at home sleep study is sufficient as a source for diagnosing OSA - regarding the Medical Insurance coverage? (i.e. are there circumstances where the Medical Insurance will not cover a sleep appliance (E0486) because the patient had an at home sleep study done instead of at a facility? - the patients in question would have been Dx with OSA and Rx a CPAP but are non-compliant and seeking alternative treatment).
Patty
Mahoney Family Dentistry
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Hi Patty!
Great question. It is possible that an insurer will not consider a Dx from an HST sufficient for coverage for an oral appliance for OSA - but this now very rare among insurers! A majority of insurers now allow Dx from an HST (some even now requiring HST before in-lab PSG for generally healthy patients showing symptoms of OSA), as along as the study is read and diagnosed by a board certified sleep physician. If the same insurer paid for the CPAP based on the HST diagnosis for this patient, the oral appliance should be no different as they are both classified as DME (durable medical equipment).
The best way to be sure is to visit the insurer's website and view the medical policy for sleep testing. Let us know if you need help locating the policy.
Hope this helps!
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 1 user thanked courtneydsnow for this useful post.
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