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When searching through the forum, I found 2 possible codes to use for a repair on an oral appliance for sleep apnea:
1.) E0486 or S8262 and use modifier RP which means replacement or repair
2.) K0739 - REPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT OTHER THAN OXYGEN REQUIRING THE SKILL OF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES
If we billed E0486 with modifier NU at time initial appliance was delivered back in April of 2012 which is the correct code to use for the repair?
Thank you.
Lyndsey
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Hi Lyndsey!
Great question! It may depend on the nature of the repair, and/or what code(s) the insurer prefers!
As you stated, many insurers will accept HCPCS code "E0486" with modifier "RP" to process the repair of a custom made oral appliance for obstructive sleep apnea.
(usually, S8262 will be more appropriate for an orthotic used to treat TMD).
However some insurers may prefer you use the "K" and "L" codes listed below to indicate the labor component (requiring skill of technician vs. not) vs. repair/replacement of minor parts.
-K0739 - REPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT OTHER THAN OXYGEN REQUIRING THE SKILL OF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES
-L4205 - Repair of orthotic device, labor component, per 15 minutes
-L4210 - Repair of orthotic device, repair or replace minor parts
If in doubt, it is always helpful to call the insurer and ask what codes they prefer!
Hope this helps, let me know if you have any further questions!
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Rank: Guest
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Hi There can anyone help me figure what the replacement HCPCS code S8262 is? This code is no longer active .
Thank you,
Angela
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Rank: Administration
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Hi Angela! No problem, here is a link to our tip of the week that covers the discontinuation of S8262 with alternate coding options!
http://www.dentalwriter....s_view.aspx?articleid=76 Please feel free to contact us with any further questions!
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Rank: Guest
Joined: 9/8/2012(UTC)
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Hello,
do the insurance companies still take the code K0739 for repairs?
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Rank: Advanced Member
Joined: 7/22/2014(UTC)
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Hi Guest!
Some insurers may prefer you use the "K" and "L" codes listed below to indicate the labor component (requiring skill of technician vs. not) vs. repair/replacement of minor parts.
-K0739 - REPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT OTHER THAN OXYGEN REQUIRING THE SKILL OF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES
-L4205 - Repair of orthotic device, labor component, per 15 minutes
-L4210 - Repair of orthotic device, repair or replace minor parts
Hope this helps!
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