Hi Jill!

Great question. Yes you are correct - if there is an "effective end date" on the PDAC list for E0486, it is no longer cleared so wouldn't qualify for the medical insurers who require a PDAC appliance be used to be eligible for reimbursement. (i like to short that list by "effective begin date" by clicking the column header to sort in descending date order, so all of the older ones with effective end dates drop to the bottom of the list!). Not all medical insurers currently require this, but we do see more and more insurers over time implement this requirement.

As for the Medicare paperwork: yes you do need either a private contract or an ABN signed if you are providing a service to a Medicare beneficiary that would be covered by Medicare. What i mean by that: you don't need one for EVERYTHING, for example, routine dental services. Medicare never covers routine dental services so you don't need anything signed for that. But, since Medicare would cover a custom made sleep appliance for a patient that meets criteria, you need a private contract or ABN.

If you are officially opted out of Medicare, you have the patient sign a private contract (that basically states you have informed them that you are opted out of Medicare so it is a cash pay deal, and no one can file a claim to Medicare for the services (neither you nor the patient).

If you are not officially opted out of Medicare but are just not currently enrolled as a Medicare DME supplier (which is what gives you the ability to file claims to Medicare for custom made sleep appliances), then you would have the patient sign an ABN form.


Hope this helps!

Hi Jill!

Thank you for the kind words!

Here is the link to where you can search if your provider is officially opted out of Medicare:
https://www.medicare.gov/forms-help-resources/find-providers-whove-opted-out-of-medicare


If find you are not opted out, best thing to do is call the Medicare contractor (MAC) for your region to see what your current enrollment status is. If you tell me what state you're in, i can provide you the contact information for the appropriate MAC's (Part A/B MAC and the DME MAC) for your region.

You can also sign up for a PECOS online account where you can manage all your Medicare enrollment information online.
PECOS online: https://pecos.cms.hhs.gov/pecos/login.do#headingLv1


If you're interested in learning more about Mediare and medical billing in dentistry, we offer excellent seminars for Cross-Coding medical billing in dentistry! We have both live & virtual attendance options. Here is a link to more info on those seminars: https://niermanpm.com/dental-continuing-education/medical-billing/crosscoding-course

Hope this helps!

Hi Jill!

Ok great. I would recommend going ahead and registering for a PECOS log in, it makes all of this easier in the future! :)

For Wisconsin, you are in Jurisdiction 6 for Medicare Part B, and your Medicare Part B MAC is National Government Services (NGS). Their enrollment inquiry number is: 877-908-8476. Here is a link to their contact info page: https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/header/contact-us/

For Medicare DME (this is the part of Medicare that pays for sleep appliances), you are in Jurisdiction B, and your MAC for wisconsin is CGS. Their provider contact number is: 866-590-6727. Here is a link to their contact info page: https://www.cgsmedicare.com/jb/contact/index.html

Medicare DME enrollment goes through the National Supplier Clearinghouse (NSC) which is managed by palmetto. Their numbmer is: 866.238-9652. Here is a link to their site: https://www.palmettogba.com/nsc

Hope this helps!

Edited by user Monday, May 17, 2021 8:22:31 AM(UTC)  | Reason: Not specified