Oral Appliances for Obstructive Sleep Apnea

Medicare covers custom fabricated mandibular advancement oral appliances (HCPCS E0486) for OSA when the beneficiary has an in-person clinical evaluation by a non-dental treating practitioner, a qualifying Medicare-covered and FDA-approved sleep test meeting specified AHI/RDI thresholds and event-count minima, the device is ordered after review of the sleep test report by the treating practitioner, and the appliance is provided and billed by a licensed dentist (DDS/DMD). Prefabricated devices (E0485) are not covered; coverage is denied if documentation, ordering, sleep-test type/quality, or supplier requirements (SWO/WOPD, proof of delivery) are not met.

"A custom fabricated mandibular advancement oral appliance (HCPCS E0486) is covered when the beneficiary has an in-person clinical evaluation by the treating practitioner before the diagnostic sleep..."

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