Tuesday, September 20, 2022

Does Medicare Cover Sleep Apnea Oral Appliance

Where Can I Get An Oral Appliance For Sleep Apnea

Are ORAL APPLIANCE DEVICES for snoring and sleep apnea COVERED by MEDICAL insurance?

If you suffer from obstructive sleep apnea and are looking for relief other than a CPAP machine, contactDr. Jeffrey W. Cross, D.D.S., F.A.G.D. Dr. Cross has been using oral appliance therapy and mouthpieces to treat sleep apnea since 2005. He is a member of the American Academy of Dental Sleep Medicine as well as the Academy of Clinical Sleep Disorders Disciplines. Dr. Cross has completed hundreds of hours of continuing education and is highly experienced in his field.

Contact Dr. Crosstoday at for a better nights sleep to learn more about treating your sleep apnea with a mouthpiece.

Will My Medicare Coverage Pay For A Sleep Apnea Oral Appliance

Though Medicare typically does not cover dental treatment costs, your coverage may cover all or some of the costs of a custom oral appliance from Quality Dentistry at Walnut Pond. Certain criteria usually must be met to qualify for Medicare coverage, however this usually requires simply receiving consultation, diagnosis, and treatment from our team and other participating physicians.

If you are looking for relief from OSA, and are currently covered by Medicare, schedule an appointment with Drs. Carson Ferris-Zeolla or Victoria Uryniak to see whether an oral appliance could be the best solution for you. Our custom-fitted oral appliances are used in place of a CPAP machine or oral surgery. While oral appliances are right for every sleep apnea sufferers, many patients discover they are able to sleep easier and wake more rested when using an oral appliance. Our staff can help provide the necessary documentation and information you need to qualify for significant cost savings with your Medicare plan.

If you or a loved one suffers from sleep apnea, dont wait to receive treatment at 908-200-7007.

Why People Are Choosing Oral Appliances For Sleep Apnea

People with underlying health conditions like diabetes or heart disease may not benefit from these non-invasive treatment methods. They may need surgical intervention or a CPAP . A CPAP is one of the most common methods used in treating sleep apnea, but it can be quite inconvenient. You need to cover your mouth and nose with a mask, plug in the device, and sleep with a constant flow of air. Many people cant tolerate it. Its often uncomfortable, but it has been shown to cause immediate results in patients.

To get the best therapy possible for you, seeing a specialist is highly recommended. Theyll often prescribe a home sleep study and go over your results with you. After you see a specialist, the dentist is a good place to go. They can help fit your oral appliance.

When youve decided to go the route of an oral appliance, the options may seem overwhelming. Its hard to choose which appliance is best for you, even with professional recommendations. There is bound to be a little bit of discomfort when you first start wearing your appliance. The discomfort is usually around the jaw or the ears. Rest assured this should pass over time. Your mouth needs to adjust to a new foreign object. When you take your appliance out in the morning, the discomfort should go away.

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Does Medicare Offer Coverage For Sleep Apnea Oral Appliances

Medicare, the program for seniors and people with certain disabilities, does provide coverage for custom oral appliances for OSA and covers specific oral appliances. For a dentist to receive reimbursement from Medicare or to bill Medicare for an oral appliance for sleep apnea, the treating dentist must enroll their practice location as a Medicare DME Supplier. An application can be submitted to become a licensed DME supplier using the form CMS 855S. Once a facility becomes a DME supplier, all dentists practicing in that location are authorized for Medicare reimbursement. We get many questions about DME supplier credentialing. For those practices who are wanting to simplify the process, contact Maura Lovett at 561-575-0737 ext. 1001.

How Much Do Sleep Apnea Mouthpieces Cost

Does Medicare Cover Sleep Apnea?

The average cost for a sleep apnea mouth guard is estimated at $1800 $2000. This includes the actual sleep apnea mouthpiece, dentist visits, adjustments, follow-ups, and modifications to the dental device. Most health insurance companies and Medicare cover oral devices for sleep apnea.

For more details on sleep apnea mouthpieces and prices, take a look at our review page here.

To arrange for a sleep apnea mouthpiece, contact your local dentist or primary care provider.

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Does Medicare Cover Dental Appliances To Treat Sleep Apnea

Sleep apnea is a serious disorder that affects your bodys ability to breath while you are sleeping. It results in your breathing stopping and restarting randomly, which can be dangerous for your overall health. The most common form of sleep apnea is obstructive sleep apnea, and Medicare does offer coverage for some dental appliances that can be used by Medicare recipients to address this issue.

What is Sleep Apnea?Sleep apnea is described as a sleep disorder that results in the cessation of breathing, and the various types include obstructive sleep apnea, central sleep apnea, and complex sleep apnea syndrome. Obstructive sleep apnea is by far the most common sleep apnea diagnosis, and it is the main problem that Medicare coverage offers services for.

Obstructive sleep apnea occurs when the muscles in the back of the throat relax. These muscles are responsible for providing support for the tonsils, throat, and tongue, and when they relax, the opening in your mouth and throat can become much smaller. This limits airflow and can make it difficult for your body to get enough oxygen as you sleep.

If the body senses that its oxygen levels are dropping too low, it briefly wakes the individual up to improve breathing and increase airflow by contracting the throat muscles and opening the airway. However, this period of awakening is usually very short and often unnoticeable.

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Provide An Approved Medicare Appliance

Not all oral appliances are created equal. Medicare only covers the ones listed on their approved PDAC list. Most recently, this list was restricted to a couple dozen different appliance variations, of which several were SomnoMed appliances.

Other examples of oral appliances covered include those that involve a fixed mechanical hinge, such as designs that mimic a TAP or Herbst appliance. As such, they can be adjusted yet fit securely when the patient sleeps.

Trying to provide an alternative form of oral sleep appliance would automatically result in a rejection of Medicare benefits, no matter how hard you try to support your claim. Only approved custom appliances are covered, regardless of your patients needs.

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How Do I Find Out How Much My Health Insurance Company Will Cover

Please give us a call and we will be happy to assist you by answering your questions and setting up a consultation with one of our sleep medicine physicians to ensure youre a candidate for our ApneaGuard services.

Just like CPAP therapy, there are several required records that we must have in order to acquire coverage. Medical insurance companies do not cover treatment for snoring only.

  • In order for a physician to prescribe therapy to treat sleep apnea, a sleep study is required in order to diagnose the patient with sleep apnea. Many payers require this as well
  • Most insurance companies do NOT require a trial of CPAP or failure of CPAP therapy in order to cover oral appliance therapy. Rarely, oral appliance therapy is covered under a dental plan. The VAST majority of the time it is covered under major medical or under the medical insurance DME coverage
  • If there are providers within the network, what is my coverage if I see an out-of-network provider?

Finding A Specific Code

Oral Appliance Therapy (OAT) for Obstructive Sleep Apnea (OSA) & Snoring

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How Can I Predetermine If Medical Insurance Covers An Oral Appliance

Start by making a call to the eligibility & benefits department using the contact numbers from the patients medical insurance card. Its important to have sleep study information before the benefits verification call because the severity of OSA must be known before the benefits can be determined. Most health insurance plans categorize oral appliances for OSA as medical equipment, so reimbursement is typically under the coverage for Durable Medical Equipment . DME is the benefit category for medical equipment such as electrical stimulators for pain, wheelchairs & walkers. The information to receive during the benefit verification:

  • Deductible amount
  • How much of the yearly deductible has been met
  • Copayment amounts or percentages
  • Preauthorization requirements
  • Is a Medicare-approved oral appliance necessary ?
  • Is a GAP exception allowed for out of network providers ?

Have Questions Ask Angela

If youre ready to take control of your sleep apnea andnot break the bank in the process, be sure to askAngela, our Insurance Coordinator, about Medicare. Shell answer any questions you might have and make sure you always know what to expect throughout the care process. You can afford top-quality sleep apnea treatment, and to learn more,give us a call today.

EZ Sleep Solutions provides Obstructive Sleep Apnea care to Mangum, Altus, Elk City, Hobart, Wellington and other neighboring cities.

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Does Medicare Cover Oral Devices For Sleep Apnea

When you suffer from sleep apnea, you know relief is of the utmost importance. It is not only a matter of getting a better nights sleep, but also a matter of improving your health. Obstructive sleep apnea, or OSA, is known to increase blood pressure. It has also been linked to a number of other cardiovascular problems. That is why finding appropriate and effective OSA treatment is so important.

As with any medical piece of equipment, paying for devices to treat sleep apnea can get pricey. Its important to know what your insurance may or may not cover so you can be prepared to pay the balance. Lets take a look at sleep apnea, the treatments for it and whether Medicare covers some equipment.

Need To Know Medicare Guidelines For Oral Appliances For Osa: Friend Or Foe Part 4

Medicare for Custom Made Oral Appliances for Obstructive ...

In this edition, I have asked Courtney to outline the Medicare rules and guidelines that dental offices MUST know in order to file Medicare. This is vital information! I encourage you to keep copies of this article for a quick reference for you and your employees. I want to thank Courtney for her commitment to the advancement of Dental Sleep Medicine.

Without further ado, lets explore some main points to be aware of when billing Medicare for oral appliances for OSA.

How Can My Dentist Help Treat Osa

Once OSA has been diagnosed, treatment may vary. For many patients, lifestyle changes such as losing weight or stopping tobacco use, can actually eliminate sleep apnea. Other patients may struggle with long-term sleep apnea. Either way, appliances that aid breathing can improve normal oxygen flow and reduce the stopping and starting of breathing throughout the night.

Drs. Carson Ferris-Zeolla and Victoria Uryniak can help patients who suffer from OSA by fitting a Jaw Advancing Device or Mandibular Advancement Device these custom-fitted mouth pieces fit snugly around a patients teeth and can effectively improve sleep apnea as well as reduce or eliminate snoring.

Both the JAD and MAD, when in place, move the jaw forward, increasing the diameter of the upper airway and preventing throat muscles from relaxing to the point of obstruction. These devices are best suited for patients with more mild forms of obstructive sleep apnea, who may be attempting to make lifestyle changes to eliminate their symptoms.

Costs Of Sleep Studies

Chances are, youâll need a sleep study to diagnose your sleep apnea. The results of this test can also help you qualify for treatment coverage from your insurance company.

These overnight exams can cost $600 to $5,000 or more each night.

At-home sleep apnea tests are also available and typically run between $150 and $500.

Your insurance may cover all or part of the expense.

Can We Bill Follow

Yes, you can bill commercial carriers, using a medical office visit code, for the adjustments to the oral appliance. Most carriers bundle the first 90 days of adjustments into the code for the custom appliance .

With the right tools to navigate medical insurance billing, you can help more of your patients receive the care they need saving lives and relationships. Your patients will thank you!

Rose Nierman, RDH, is the Founder and CEO of Nierman Practice Management, an educational and software company for Medical Billing for Dentists, TMD and Dental Sleep Medicine advanced treatment, and co-founder of the SCOPE Institute, a non-profit educational organization dedicated to the advancement of sleep apnea, craniofacial pain treatment, and medical billing within dentistry. Rose and her team of clinical and medical billing experts can be reached at or at 1-800-879-6468

The Practice Location Must Be Enrolled As A Medicare Dme Supplier Either Participating Or Non

Sleep Apnea treatment CPAP alternative: Oral appliance therapy by Dr. Bruce A. Kanehl

Currently, custom made oral appliances for OSA are categorized as Durable Medical Equipment under Medicare. DME is a broad range of items that are used by a patient in a home setting to serve a medical purpose, such as wheelchairs, positive airway pressure devices, canes, the list goes on. To bill Medicare for DME items, a practice must enroll as a DME supplier using the 855s application. While this is not a quick process, it can be well worth it as Medicare is the largest medical insurer in the United States.

What Does A Cpap Machine Do

A CPAP machine provides airflow at pressure to keep a persons airway open.

CPAP equipment includes a machine, tubing, and a mask that a person wears while sleeping. Different types of masks include:

  • a mask that fits over the nose
  • a mask that covers the nose and mouth
  • nasal pillows that fit in the nostrils

CPAP machines may also have a humidifier attachment to help ease discomfort in a persons nose or throat.

Medicare Supplement Coverage For Medicare Part Bs Out

Medigap plans, offered by private insurance companies, can help you pay your out-of-pocket costs for services covered under Original Medicare.

If you think you need more coverage for your sleep apnea, wed like to help. You can schedule an appointment by clicking the link below, or let me email you some personalized info to review. Or you can check out possible plans for yourself by clicking the Find Plans button on this page.

This website and its contents are for informational purposes only. Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

We Accept Medicare For Sleep Treatment

For people without traditional medical insurance who are worried about being able to afford sleep apnea therapy, we have good news: Medicare can be used to pay for a sleep oral appliance, and EZ Sleep Solutions is happy to accept many different Medicare plans as well. And, depending on your particular plan, Medicare can be used to cover much more than just an oral appliance. Our team can make the claim process nice and simple–well handle all the paperwork so you can save as much as possible without having to stress or wait. To learn how we could use your specific plan to help pay for your sleep care,give us a call today.

The Coverage Criteria Is Different For Mild Moderate And Severe Osa

Oral Appliance Therapy

The Medicare LCD for oral appliances for OSA states the coverage criteria for mild, moderate, and severe OSA as follows:The beneficiary has a Medicare-covered sleep test that meets one of the following criteria :

  • The apnea-hypopnea index or Respiratory Disturbance Index is greater than or equal to 15 events per hour with a minimum of 30 events or,
  • The AHI or RDI is greater than or equal to 5 and less than or equal to 14 events per hour with a minimum of 10 events and documentation of:a. Excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia or,b. Hypertension, ischemic heart disease, or history of stroke or,
  • If the AHI> 30 or the RDI> 30 and meets either of the following :a. The beneficiary is not able to tolerate a positive airway pressure device or,b. The treating physician determines that the use of a PAP device is contraindicated.
  • An important point to understand on the coverage criteria above: do not let the inclusion of RDI fool you! Later in the policy, RDI is defined:

    The respiratory disturbance index is defined as the average number of apneas plus hypopneas per hour of recording without the use of a positive airway pressure device. For purposes of this policy, respiratory effort related arousals are not included in the calculation of the RDI. The RDI is reported in Type III, Type IV, and other home sleep studies.

    Advanced Beneficiary Notification Option

    For providers contracted with Medicare , when same and similar is on file and the time is over day 91 or PAP certification has been signed by the MD, it is strongly recommended to have the beneficiary sign an advanced beneficiary notification . If the beneficiary opts to submit the claim to Medicare, the claim would be submitted with the second modifier denoting the ABN is on file. This will inform Medicare that the supplier feels the item will not be a covered service and the beneficiary has been informed of this and why.

    As always, if the supplier is nonparticipating, it is required to collect in full prior to submitting the claim any remittance will go to the beneficiary. If the supplier accepts assignment, it is in network for that claim only and cannot balance bill to their fee, only collect Medicare allowance. If the supplier is participating and there is sufficient reasoning why the claim will deny, and the member has signed the ABN accepting financial responsibility, then the office can collect money prior to the denial .

    Finally, what if the physician orders oral appliance therapy as firstline treatment and it is not effective?

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