Hello and Happy New Year to Everyone on the Forum,

Good News for the beginning of the year:

Medicare has approved two additional appliances for sleep apnea reimbursement. Now, the TAP, SUAD and Herbst are approved for Medicare reimbursement from specific manufacturers.
With oral appliances being a front-line treatment for mild to moderate obstructive sleep apnea, Medicare performs appliance reviews. They have set coding guidelines which include one piece appliances with a particular hinge design. This is important for dentists in critical appliance selection for your senior patients.

The current Medicare approved appliances and labs (as of January 7th 2013):

HERBST ADJUSTABLE, DYNAFLEX
UCLA MODIFIER HERBST, SPACE MAINTAINERS LABORATORY
HERBST SLEEP APPLIANCE, GERGEN’S ORTHO LAB
TELESCOPIC HERBST SLEEP APPLIANCE, GREAT LAKES ORTHODONTICS LTD
TAP, TAP 3 ELITE, AIRWAY MANAGEMENT
TAP TL, SPACE MAINTAINERS LABORATORY
SUAD DEVICE, SUAD ELITE, STRONG DENTAL LTD

Hopefully, we’ll see even more appliances and labs make the list this year!

Bill the medical code, E0486, when the appliance is Medicare approved and your office has complete documentation as stated in Medicare guidelines.

At this time, commercial carriers reimburse for the many oral appliances which are FDA approved and have not set hinge design requirements.

Happy New Year!

Rose Nierman
CEO and Founder