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Guess what appliances just got cleared for Medicare - Tip of the Week 7-13 to 7-17, 2015

Friday, July 17, 2015

Did you miss the last tip of the week? No problem, view it below!

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The sessions are organized into categories to help you find what you're looking for - or something you didn't even know you were looking for! Follow the links below to see all of the available recordings in each category:

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 2 more oral appliances PDAC cleared for Medicare!




On July 2nd 2015, 2 appliances gained PDAC clearance for E0486 for Medicare
, making a total of 21 appliances currently cleared!

The 2 new appliances on the PDAC list for E0486 are manufactured by Dream Systems, LLC:



Below is a screenshot of all of the currently PDAC cleared appliances for Medicare


PDAC clearance of the custom made oral device that is supplied to a Medicare patient is a requirement in the criteria for coverage in Medicare’s LCD for Oral Appliances for Obstructive Sleep Apnea.

The LCD’s state:

“Code E0486 may only be used for custom fabricated mandibular advancement devices. To be coded as E0486, custom fabricated mandibular advancement devices must:

1. Have a fixed mechanical hinge (see below) at the sides, front or palate, and,
2. Have a mechanism that allows the mandible to be advanced in increments of one millimeter or less, and,
3. Be able to protrude the mandible beyond the front teeth at maximum protrusion, and,
4. Be adjustable by the beneficiary in increments of one millimeter or less, and
5. Retain the adjustment setting when removed, and,
6. Maintain mouth position during sleep so as to prevent dislodging the device.”

To view the current PDAC cleared list:

· Visit:
· Click "Search DMECS for codes and fees" on the left side of the page
· At the bottom of the webpage under "Search DMEPOS Product Classification List”, type in "E0486" into the field box labeled "HCPCS Code", then click "Go".
· The list of appliances will appear. Any appliance/manufacturer with a start date, but no end date is currently PDAC cleared!

This list does get updated, so check back regularly for updates!

Still not enrolled in Medicare to bill oral appliances for OSA?

Did you know Medicare is the largest health insurer in the United States?

As of January 3rd, 2011, Medicare announced custom made oral appliances for Obstructive Sleep Apnea (OSA) are a covered benefit. Thousands of dental practices across the United States have taken advantage of Nierman’s DME Application service to enroll their facility as a participating or non-participating DME supplier in order to bill Medicare for the treatment and grow their sleep practices.

Why should your Dental Practice become a Medicare DME Supplier?

1.       50 million patients: With over 50 million Medicare patients and an expected 64 million by 2020, becoming a DME supplier increases your OSA patient pool significantly. More than 10 million of those patients have supplementary private insurance plans (Medigap).

2.       Become a one stop shop for OAT referrals: Give physicians the peace of mind to refer all oral appliance patients to you without having to consider whether the patients have private insurance or Medicare.

3.       Medicare patients don’t have to be a loss leader: With low cost Medicare appliances, streamlined medical billing processes and the ability to balance bill patients, making a profit on Medicare Oral Appliance cases is not only possible, but common among many Dentists the Nierman team has helped become DME suppliers. Let us help you get there.

Get Approval Quickly. Let Nierman Practice Management Prepare Your Medicare DME Application.

Become a DME Supplier



Why Nierman’s Medicare DME application service?

1.       We do the dirty work
Did you know the Medicare DME application (the CMS 855s application) is 25 pages long? We will provide you with a 5 page sheet of the required information we need to complete entire 25 pages for you

2.       We know what Medicare wants
The Medicare DME application is not just completing the application. There are several supporting documents (a copy of comprehensive liability insurance policy with NSC listed as a certificate holder, for example) that are required in order for your application to process. We guide you through preparing these mandatory documents and make sure they meet Medicare’s requirements.

3.       Get it right the first time
Did you know if something goes wrong in the application process, you might have to start all over and pay your application fee ($542 for 2014) again as well? Our experts follow up with Medicare on the status of your application to ensure it doesn’t get lost in the shuffle.

4.       We make sure you are prepared
Did you know that a site visit will be conducted at your office as part of the application process? We supply all the information you need to meet the requirements of the site visit to keep it short and efficient. You will also receive Rose Nierman’s Medicare Manual as well!

5.       Don’t wait longer than you should
Our average turnaround time for a DME application is only 10 weeks! Don’t find yourself waiting 6 months or more to get started with your Medicare patients.


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