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slfdfm
#1 Posted : Wednesday, November 13, 2013 3:03:05 PM(UTC)
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slfdfm

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I do medical cross coding. I need a dental code to link to the D0486 medical code, so I can create the claim form. Is there a dental code that I can use to cross code with?
I will link the 99204 to D0150
99213 and 99214 to D0140

Edited by user Wednesday, January 12, 2022 4:47:31 PM(UTC)  | Reason: update

courtneydsnow
#2 Posted : Friday, November 15, 2013 8:59:27 AM(UTC)
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courtneydsnow

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Hi slfdfm!

Did you mean medical HCPCS code E0486 for a custom made oral appliance for OSA?
Guest
#3 Posted : Monday, February 20, 2017 4:16:46 PM(UTC)
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I am using practice work software and need the cross code for E0486 to bill out. E0486 gives me an error message.
courtneydsnow
#4 Posted : Monday, February 20, 2017 4:27:13 PM(UTC)
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Hi Guest!

There is not a direct crosscode for a CDT code for the medical HCPCS code E0486, which stands for: ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR NON-ADJUSTABLE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT

I know that some offices will make up a "dummy" code to use for it, however you will need to contact practice works for more information on that.

If you would like to see a short video on how our software DentalWriter works, which is specifically designed for dentists billing medical insurance for medically necessary services such as sleep apnea appliances and TMD services, here is a link: https://www.youtube.com/watch?v=1S656MySCbw&feature=youtu.be

If you would like to schedule a demo with one of our team members, you can do so here: https://niermanpm.com/demo
Kay Davis
#5 Posted : Friday, December 15, 2017 10:12:12 AM(UTC)
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Guest

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Can you assist me with the correct CPT code for sleep apnea device in dental pls?
courtneydsnow
#6 Posted : Friday, December 15, 2017 10:30:25 AM(UTC)
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courtneydsnow

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Hi Kay!

The HCPCS code for a custom made oral appliance for sleep apnea is E0486.

Hope this helps!
Guest
#7 Posted : Wednesday, March 28, 2018 1:30:00 PM(UTC)
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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?

Kay
#8 Posted : Wednesday, March 28, 2018 1:31:30 PM(UTC)
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Guest

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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?
mbrzezinski
#9 Posted : Wednesday, March 28, 2018 5:09:35 PM(UTC)
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mbrzezinski

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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!
Kay
#10 Posted : Wednesday, April 11, 2018 9:54:50 AM(UTC)
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Thank you so much you are awesome and a great help.

Kay Davis
Rose
#11 Posted : Wednesday, January 12, 2022 5:03:01 PM(UTC)
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Rose

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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.

Edited by user Wednesday, January 12, 2022 6:42:47 PM(UTC)  | Reason: Not specified

Guest
#12 Posted : Monday, March 14, 2022 12:56:37 PM(UTC)
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Hi, We are dental office and want to start billing for Sleep Apnea Appliances, but not too familiar with this... Does the dental provider use E0486 and bill on a 1500 claim? I understand there are new Dental codes, D9947. Do we use the new dental code or continue using E0486? I appreciate your help!

Edited by user Monday, March 14, 2022 1:04:53 PM(UTC)  | Reason: typo

courtneydsnow
#13 Posted : Monday, March 14, 2022 3:06:05 PM(UTC)
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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!
Guest
#14 Posted : Wednesday, July 13, 2022 3:08:33 AM(UTC)
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hcmsus
#15 Posted : Friday, March 3, 2023 8:45:52 AM(UTC)
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Guest
#16 Posted : Thursday, July 20, 2023 6:09:09 PM(UTC)
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Hi there! I am trying to help a member file a claim for E0486 with his medical insurance, however the insurance does not have pricing for this code. Is there another CPT code that could possibly be used that we could try?

Thanks in advance!
courtneydsnow
#17 Posted : Friday, July 21, 2023 8:40:14 AM(UTC)
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Hi Guest!

If the appliance is a custom made intra-oral appliance to treat Obstructive Sleep Apnea, then E0486 with modifier NU is the correct code to use. Although some medical insurers do not have a set amount for it on their fee schedule, this code is reimbursed by Medicare and most (if not all) private payers as well. Depending on your region, we typically see the fee at approx $2500-4000, and depending on the region and the payer we typically see the allowed amount approx $1800-2400.

Hope this helps!
Guest
#18 Posted : Friday, July 21, 2023 11:08:33 AM(UTC)
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Thank you very much! The insurance is Anthem, commercial policy. He paid $1792.00. Sadly, he has been told he would need a different code since there is no pricing with that code.
courtneydsnow
#19 Posted : Monday, July 31, 2023 9:12:04 AM(UTC)
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Hi Guest!

Yes we have been getting reports of a few insurers trying to deny claims for E0486 stating the reason being that E0486 currently shows as $0 on Medicare DME's fee schedule, which is true even though Medicare has officially paid for this code since 2010. So typically, the best response in this situation is to appeal & provide the insurer with a copy of a recent as possible EOB from Medicare DME showing the current allowed amount for E0486.
Guest
#20 Posted : Saturday, September 9, 2023 11:16:21 AM(UTC)
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Since E0486 in still not on the Medicare fee list, what have you recently been seeing for reimbursement or "allowed" in Georgia?
Thanks in advance.
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