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Last 10 Posts (In reverse order)
Ethan02 Posted: Monday, March 28, 2022 7:59:03 AM(UTC)
Message was deleted by a Moderator. | Reason: Not specified
courtneydsnow Posted: Friday, March 16, 2018 8:40:45 AM(UTC)
Hi drlmdds!

Great question. It depends! The short answer is likely, no. However! Here's the deal:

When you bill Medicare for a custom made oral appliance for OSA that is not PDAC approved, the LCD instructs you to code the appliance as A9270 instead of E0486.

A9270 stands for: non-covered item or service

So of course, likely the claim will be denied, but you can appeal it so it goes to medical review if there is a good medical reason why the patient did not get an appliance that is PDAC approved. If it was just a preference with no good reason, they may not cover.

I would certainly be sure to have the patient sign an ABN so that if Medicare ultimately does not cover it, the patient is responsible for payment.

Hope this helps!
drimdds Posted: Thursday, March 15, 2018 2:41:12 PM(UTC)
We are a non participating medicare provider. If the patient wants to get a non medicare covered sleep appliance will medicare still pay their portion and the patient will pay the difference?