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Medical Insurance Billing for the NTI-DDS |
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Oral Appliance Therapy can be billed under the patients medical insurance with a CMS 1500 form using:
ICD-9 Code 327.23 - Obstructive Sleep Apnea, and;
CPT code E0486 - Custom fabricated, adjustable/non-adjustable oral appliance to prevent airway collapsibility
Medical insurance allows you to check the benefits to see if Oral Appliance Therapy is covered (called a pre-determination), but they normally will not let you know how much. You will want to check the patient's deductibles, in/out of network benefits (if you are an out of network provider you may need to request a gap exclusion). You will also need to ask them if a pre-authorization is required, and if so, how to go about that.
Please also note that most insurance companies will require the patient to have a diagnosis of OSA from a Polysomnogram (overnight sleep study) to cover oral appliance therapy. It is important to check the criteria to get the service covered (for exmaple, some companies will cover oral appliances as a first line of treatment for mild & moderate patients, but a severe patient must have a documented intolerance to CPAP before an oral appliance will be covered).
Please download these documents to assist you:
Letter of Medical Necessity
Medical Codes
Oral Appliance Reimbursement
Sample Insurance Form
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