Hi Guest!

Medicare's allowed amount for E0486 for California is approximately $1320. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!

Hi Guest!

No problem. Medicare DME does not cover E0485, and the allowed amount for Washington DC for E0486 is approximately $1869.95

Hope this helps!

Hi Guest!

Medicare's allowed amount for E0486 for Oklahoma is approximately $1100. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!

Hi Guest-CDC!

Medicare's allowed amount for E0486 for Minnesota is approximately $1367. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!

Hi Guest In SC!

Great question. Here is a link to more information on Medicare's requirements for facilities providing "advanced imaging" like CT's, MRI's, etc: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Accreditation-of-Advanced-Diagnostic-Imaging-Suppliers.html

Hope this helps!

Hi Guest!

Medicare's allowed amount for E0486 for Idaho is approximately $1300-1350. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Unfortunately, currently none of the 4 Medicare DME jurisdictions have the allowed amount for E0486 published on their fee schedule (even though Medicare DME has offered coverage for E0486 since at least 2010!).

The figures I am providing are based on EOB's from successfully processed Medicare claims for E0486 from our medical billing service we offer to our clients, as well as reports from our clients who do their own medical billing.

Hopefully the allowed amounts for E0486 will be published to Medicare DME's fee schedules soon!! :)

Hi Guest!

Medicare's allowed amount for E0486 for Georgia is approximately $1100-1150. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!

Hi Guest!

Great question. You do have several options available when submitting to Medicare.

For our DentalWriter software clients, we suggest the use of APEX clearinghouse, as our software is directly integrated with APEX, so once the claim is ready to submit, the user only has to click a few buttons to send the claim straight through. If you are a DentalWriter software client, feel free to give us a call and we can help you get set up with APEX. If you are not a DentalWriter software client - when it comes to choosing a clearinghouse it really comes down to which one are you most comfortable with and you like the pricing best for :) Some popular ones out there are office ally, availity, emdeon....there's many choices!

If you are billing custom made oral appliances for Obstructive Sleep Apnea (OSA) (HCPCS code E0486) to Medicare DME - you can certainly submit paper claims, however be aware Medicare does put a 28 day hold on paper claims, so you will see a much longer turn around/processing time. Most electronic claims submitted to Medicare DME are processed within a few weeks.

Hope this helps!

Hi Guest,

Medicare's allowed amount for E0486 for North Carolina is approximately $1100-1150. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!

Hi Guest!

The most recent EOB from Medicare DME for colorado that I have shows an allowed amount for E0486 of approx. $1133.63

Hope this helps!