Oral Appliances for Obstructive Sleep Apnea - Policy Article

Medicare covers oral appliances for obstructive sleep apnea under the DME benefit when the device is reasonable and necessary and all LCD requirements (including documentation, face-to-face encounter, and a WOPD where required) are met. Custom fabricated mandibular advancement devices can be billed as E0486 only if they meet explicit mechanical and adjustment criteria and require no ongoing dental visits beyond a 90-day fitting period; many dental devices (tongue retaining devices, TMJ occlusal appliances, devices for snoring without OSA, and devices requiring repeated adjustments) are non-covered and must be billed as A9270.

"Oral appliances to treat diagnosed obstructive sleep apnea (OSA) are covered under the DME benefit when the device is reasonable and necessary and all requirements in the related LCD are met."

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