Billing and Coding: Oral Maxillofacial Prosthesis

Medicare covers implants to secure/attach/support maxillofacial prostheses when the prosthesis is used secondary to maxillofacial surgery or repair of traumatic injury (bill implants with CPT 21299 and document intended use and relevant dates). Oral appliances for obstructive sleep apnea are covered under HCPCS E0485 (prefabricated) or E0486 (custom), with all fittings, adjustments, supplies and repairs considered inclusive in those HCPCS payments and billed to the DME MAC rather than as separate E/M or radiology services to the A/B MAC.

"Implants to secure, attach, or support a maxillofacial prosthesis are covered when the prosthesis is being used secondary to maxillofacial surgery or repair of traumatic injury."

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