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Hi Guest!

Great question. Yes, the dental practice would use HCPCS code E0486 for the appliance (includes 90 days of follow up/adjustment typically as well) on the CMS1500 medical claim.

While there are those new codes in the CDT coding system, dental insurers don't offer coverage for custom made oral appliance to treat Obstructive Sleep Apnea (OSA), as it is considered a medical expense.

Also keep in mind, you'll need a copy of the patient's sleep study (to provide the diagnosis of OSA - some insurers require this study to be performed within the last year), as well as a prescription from a physician for the sleep appliance. There are also a few other criteria a patient may need to meet, depending on the severity of their OSA and their insurer's coverage criteria.

Here is a link to our blog with additional information about billing sleep appliances to medical:
https://niermanpm.com/blog/what-you-need-to-get-custom-oral-sleep-appliances-paid-by-medical-insurance/

Hope this helps!

2022 NEW Dental Codes for Sleep Apnea Appliance therapy

D9947 — Custom sleep appliance fabrication and placement (documentation purposes)
D9948 — Adjustment of custom sleep apnea appliance
D9949 — Repair of custom sleep appliance



These new codes went into effect in January, 2022. It is recommended to continue to bill sleep apnea appliances to medical insurance with code E0486 NU. No dental policies have indicated that oral appliances will be covered under dental insurance. so continue to bill as a medical necessity.

Hi Kay,
When you bill for the E0486 you will use modifier NU which stands for new DME. If this is a Medicare claim you will use NU and KX which states you have all required documentation on file.
On the claim there will be a diagnosis pointer which will relate the service to an ICD-10 code. Most commonly there is only one diagnosis so your pointer will be A.

Hope this helps!

Thank you so much i just found the response, I didnt know how to get back here. Do I hve to include a modifier and diagnosis pointer to bill this out from dental to medical? If so can you provide those for me please?