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Guest
#1 Posted : Saturday, October 29, 2016 8:29:42 AM(UTC)
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Guest

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Hi there,

My pt. wants to do sleep apnea appliance. Could you please tell me what dental procedure code that we could send out for P-D? D8220 is possible? And what medical diagnosis code that we could claim to medical insurance?

Thank you!

Vivian

courtneydsnow
#2 Posted : Tuesday, November 1, 2016 10:05:08 AM(UTC)
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courtneydsnow

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Hi guest!

Custom made oral appliance for Obstructive Sleep Apnea (OSA) are not billed to dental insurance, only to medical. As long as the patient has been diagnosed with OSA through a sleep study, the ICD-10 diagnosis code to use is: G47.33 - Obstructive Sleep Apnea (adult)(pediatric)

The HCPCS (procedure) code to use for the custom made appliance is E0486 - Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment

Hope this helps!
Guest
#3 Posted : Thursday, November 29, 2018 12:51:23 PM(UTC)
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Would this also be the code to use for a Rapid Palatal Expander if it was for sleep apnea purposes?
courtneydsnow
#4 Posted : Tuesday, December 4, 2018 8:42:33 AM(UTC)
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courtneydsnow

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Hi Guest!

Great question. I do not typically see palatal expanders alone coded as E0486 (although I do believe there are a few appliances out there that are FDA cleared for snoring & sleep apnea that do include a palatal expander component along with a mandibular advancement component). Many practices we work with submit this service using one of the following:
42299 - Unlisted procedure, palate, uvula
21299 - Unlisted craniofacial and maxillofacial procedure

We have also seen some practices use CPT 21142, which stands for: Reconstruction midface, Le Fort I, segment movement in any direction, without bone graft
- however, adding the modifier -52 which stands for: reduced services, to signify the lack of down-fracturing.

Hope this helps!
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