Hi Dr. Teller!

Both codes are appropriate for occlusal guards with reports. In our experience, D7880 is used more often.

Have you considered filing this to the patient's medical insurance? You will generally not see much reimbursement on the dental side for this, but with proof of medical necessity the medical insurer may cover it.

Her medical insurance deductible and out of pocket expenses are so high as to be useless at this point. She has some dental coverage for D9940. Should I submit to medical first, then dental with an EOB?

Hi Dr. Teller!

Rose replies:

Yes, if the patient has documented signs of both you can suit either code.

Hi Guest!

The code you will want to use to bill a custom made oral appliance used to treat obstructive sleep apnea (OSA) is HCPCS code E0486 (usually paired with the modifier "NU" for most insurers, which stands for "new equipment").

The oral appliance used to treat OSA should not be billed to a patient's dental insurance as it is a medical treatment, that requires a medical diagnosis - and the custom made oral appliance itself is even considered a medical device! (Durable Medical Equipment - DME).

There is much more information available in the Obstructive Sleep Apnea board of this forum as well! (also in our Tip of the Week! thread).

Hope this helps, please feel free to contact us with any further questions!

Hi guest Lo!

Great question, yes those D code can be billed to medical in many cases....in fact, many medical insurers have the D codes listed right in their medical policies as covered codes.

Basically, "D" codes are found in the HCPCS coding book, so medical insurers can process them! For example, see the link below to our recent tip of the week that addresses the discontinuation of HCPCS code S8262, there is an example of BCBS of MA medical policy for TMD that lists D7880 as a covered code:
https://www.dentalwriter.com/forum/default.aspx?g=posts&t=542

Having said that, there are a few insurers that may reject a D code and tell you to use the appropriate CPT code instead.

Hope this helps, let us know if you have any further questions!

D7880 Occlusal Orthotic Device

Hi guest!

It is possible the insurer may prefer a different code, but it is also possible that Cigna does not consider mouth pieces medically necessary for treatment of migraines. Did the denial state that dental prosthetics are not covered, or did it state anything else?

Here is a link to Cigna's medical policy for Headache and Occipital Neuralgia Treatment:
https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0063_coveragepositioncriteria_local_injection_therapy.pdf

I was unable to find a medical policy for Cigna that specifically covers Migraines, although they are mentioned in policies for treatments such as Botox and Electrical Stimulation:

Botox:
https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/pharmacy/ph_1106_coveragepositioncriteria_botulinum_therapy.pdf

Electrical Stimulation:
https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0160_coveragepositioncriteria_electrical_stimulators.pdf