D9954 — Fab/del oral appliance thxpy
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- None specified in this policy bulletin.
Key Coverage Criteria
- None. Aetna considers intra-oral appliances (e.g., the Nociceptive Trigeminal Inhibition-Tension Suppression System) experimental and investigational for the treatment of headaches and trigeminal neuralgia because the effectiveness of this approach for these indications has not been established.
1 Active Policy
AETNA-CPB-0688 — Intra-oral Appliances for Headaches and Trigeminal Neuralgia
Related Codes
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