Medicare Coverage of Oral Appliances: Including Same or Similar-Medicare Coverage of Oral Appliances: Including Same or Similar Recording

Video Transcription

Video Summary

The webinar focused on Medicare coverage for oral appliances for obstructive sleep apnea (OSA). The speakers, Judy Rohn from CGS, and Tanya Gillis and Mary Reineke Ferguson from Noridian, discussed the criteria for coverage, documentation requirements, resources available, and billing guidelines for these devices.<br /><br />Highlights included:<br /><br />1. <strong>Objectives</strong>: Attendees should understand Medicare coverage for oral appliances, documentation needed, and available resources.<br />   <br />2. <strong>Coverage Criteria</strong>: The appliance is covered if criteria A-D are met, including a clinical evaluation prior to the sleep test, a Medicare-covered sleep test, and if the device is ordered and provided by a licensed dentist post-sleep test.<br /><br />3. <strong>Documentation Requirements</strong>: Claims are subject to audit. Necessary documentation includes a standard written order (SWO), medical records, proof of delivery, and beneficiary authorization.<br />   <br />4. <strong>Coding and Billing</strong>: Only custom-made devices approved by the PDAC with a fixed metallic joint are covered under E0486.<br />   <br />5. <strong>Same & Similar Rule</strong>: Typically, an oral appliance and a PAP device are not covered simultaneously unless justified by documented medical necessity.<br /><br />The session concluded with a Q&A covering CPAP intolerance, telehealth visits, proof of Medicare enrollment, and billing clarification.

Keywords

Medicare

oral appliances

obstructive sleep apnea

coverage criteria

documentation requirements

billing guidelines

custom-made devices

CPAP intolerance

telehealth visits