Rank: Member
Joined: 10/1/2012(UTC)
Posts: 14
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Hello NB,
Great questions and thank you! We value your support for so many years as part of the Nierman Practice Management family.
According to insurers, codes that begin with “2” are not appropriate for TMD appliances. These are considered surgical codes and should only be used for surgical procedures.
HCPCS S8262 is defined as “Mandibular Orthopedic Repositioning Device, each”. I have reviewed some policies that list this code for OSA, but it’s becoming less common in medical insurance policies. HCPCS E0486-NU is the proper code for OSA appliances.
So, the S8262 is considered the TMD appliance code in the majority of medical policies. There are a few insurers not accepting this code for TMD, although many insurers have gotten on board with S8262. I have not seen this code reimbursed without your DentalWriter narrative report of medical necessity (send with the claim for best work flow). The CMS 1500 does not allow a place for a descriptor so that is not needed. Your diagnostic or narrative report will provide the description of treatment as well as "the medical necessity" of treatment.
After reviewing various medical policies, the carriers who do not accept this code, are generally publishing D7880 as the accepted code on a CMS 1500 medical claim, with the corresponding ICD diagnosis codes.
Please let me know if you have any additional questions. It's great to hear from you.
Sincerely,
Rose Nierman, CEO, Nierman Practice Management
From: NB
Sent: Sunday, November 10, 2013 9:11 PM
To: Rose Nierman
Could you verify if few things for us please?
Is S8262 code for sleep orthotics only? It still means mandibular, orthopedic, repositioning device? Does insurance want us to put in a descriptor or ?
Is 21089 code for flexible orthotic (we use this for our flexible mandibular orthotic)?
Is 21299 code for hard , outside lab made orthotic still? These 21's still need a descriptor attached to the claim?
We value your advice. Thank you, NB
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 1 user thanked Rose for this useful post.
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Rank: Guest
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Message was deleted by a Moderator. | Reason: Not specified
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Rank: Guest
Was thanked: 16 time(s) in 15 post(s)
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As of 6/30/15 S8262 is no longer being accepted as valid code do you know the replacement code?m
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest! No problem, here is a link to our tip of the week that covers the discontinuation of S8262 and alternate coding options! http://www.dentalwriter.com/news_view.aspx?articleid=76
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