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courtneydsnow
#61 Posted : Monday, January 8, 2018 5:13:57 PM(UTC)
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courtneydsnow

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Hi Guest!

Medicare's allowed amount for E0486 for California is approximately $1320. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!
Guest
#62 Posted : Thursday, February 8, 2018 10:36:38 AM(UTC)
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Can you please let me know the Medicare reimbursement rate for E0485 and E0486 for the District of Columbia?

Thanks
courtneydsnow
#63 Posted : Monday, February 12, 2018 8:41:24 AM(UTC)
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Hi Guest!

No problem. Medicare DME does not cover E0485, and the allowed amount for Washington DC for E0486 is approximately $1869.95

Hope this helps!
Guest
#64 Posted : Monday, March 26, 2018 3:44:07 PM(UTC)
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What is the medicare reimbursement for Oklahoma on the E0486?

Thanks,
courtneydsnow
#65 Posted : Tuesday, March 27, 2018 8:58:42 AM(UTC)
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Hi Guest!

Medicare's allowed amount for E0486 for Oklahoma is approximately $1100. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!
Guest-CDC
#66 Posted : Wednesday, April 4, 2018 2:37:04 PM(UTC)
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Hi,

Curious as to what the reimbursement rate for Minnesota is for E0486? Thank you in advanced!
courtneydsnow
#67 Posted : Thursday, April 5, 2018 9:29:58 AM(UTC)
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Hi Guest-CDC!

Medicare's allowed amount for E0486 for Minnesota is approximately $1367. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!
Guest In SC
#68 Posted : Wednesday, April 25, 2018 10:29:00 AM(UTC)
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Hi, we are new to Medicare, are currently part B providers.

We are looking into adding a cone beam CBCT machine to our practices.
We have one doctor/provider who works at two different businesses:
1) Sleep Practice, a medicare part B practice
2) Dental Office, NOT a medicare office
My question relates to advanced imaging using the cone beam CBCT.
Are either businesses required to attain ADI Accreditation in order to provide or bill for CBCT?

https://www.jointcommiss...C_Imaging_Flyer_2-8.pdf

Any insight you can offer on this would really be helpful.
Thanks

Edited by user Wednesday, April 25, 2018 10:47:51 AM(UTC)  | Reason: clarification

courtneydsnow
#69 Posted : Friday, April 27, 2018 5:07:15 PM(UTC)
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Hi Guest In SC!

Great question. Here is a link to more information on Medicare's requirements for facilities providing "advanced imaging" like CT's, MRI's, etc: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Accreditation-of-Advanced-Diagnostic-Imaging-Suppliers.html

Hope this helps!
Guest
#70 Posted : Thursday, May 17, 2018 9:39:15 AM(UTC)
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What is the reimbursement for Medicare in Idaho? Also, how are you calculating this figure? Or do you have a resource I can use to obtain the allowed amount?
courtneydsnow
#71 Posted : Thursday, May 17, 2018 10:24:54 AM(UTC)
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Hi Guest!

Medicare's allowed amount for E0486 for Idaho is approximately $1300-1350. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Unfortunately, currently none of the 4 Medicare DME jurisdictions have the allowed amount for E0486 published on their fee schedule (even though Medicare DME has offered coverage for E0486 since at least 2010!).

The figures I am providing are based on EOB's from successfully processed Medicare claims for E0486 from our medical billing service we offer to our clients, as well as reports from our clients who do their own medical billing.

Hopefully the allowed amounts for E0486 will be published to Medicare DME's fee schedules soon!! :)
Guest
#72 Posted : Monday, May 28, 2018 4:28:05 PM(UTC)
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What is the reimbursement for Medicare in Georgia?
Thanks!
courtneydsnow
#73 Posted : Tuesday, May 29, 2018 10:41:29 AM(UTC)
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Hi Guest!

Medicare's allowed amount for E0486 for Georgia is approximately $1100-1150. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!
Guest
#74 Posted : Thursday, June 7, 2018 9:34:13 AM(UTC)
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I am new to medicare billing. Is it better to be a direct biller or go through a clearinghouse? If so do you have any recommendations?
courtneydsnow
#75 Posted : Monday, June 11, 2018 12:02:40 PM(UTC)
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Hi Guest!

Great question. You do have several options available when submitting to Medicare.

For our DentalWriter software clients, we suggest the use of APEX clearinghouse, as our software is directly integrated with APEX, so once the claim is ready to submit, the user only has to click a few buttons to send the claim straight through. If you are a DentalWriter software client, feel free to give us a call and we can help you get set up with APEX. If you are not a DentalWriter software client - when it comes to choosing a clearinghouse it really comes down to which one are you most comfortable with and you like the pricing best for :) Some popular ones out there are office ally, availity, emdeon....there's many choices!

If you are billing custom made oral appliances for Obstructive Sleep Apnea (OSA) (HCPCS code E0486) to Medicare DME - you can certainly submit paper claims, however be aware Medicare does put a 28 day hold on paper claims, so you will see a much longer turn around/processing time. Most electronic claims submitted to Medicare DME are processed within a few weeks.

Hope this helps!
Guest
#76 Posted : Wednesday, July 18, 2018 1:05:29 PM(UTC)
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Hi!

Could you tell me what the allowable for E0486 is in North Carolina?

Thanks for your help!
mbrzezinski
#77 Posted : Friday, July 20, 2018 4:39:46 PM(UTC)
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Hi Guest,

Medicare's allowed amount for E0486 for North Carolina is approximately $1100-1150. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!
Guest
#78 Posted : Thursday, September 27, 2018 2:08:02 PM(UTC)
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Can you help me with the amount for 2018 for code E0486 - I've heard it should be close to $3000 but the last post you gave for Colorado was $1000 (I'm hoping it has increased). Thinking we should sign up as a non-assignment provider and have the insurance reimburse the patient.
Thanks for your help
courtneydsnow
#79 Posted : Friday, September 28, 2018 9:26:30 AM(UTC)
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courtneydsnow

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Hi Guest!

The most recent EOB from Medicare DME for colorado that I have shows an allowed amount for E0486 of approx. $1133.63

Hope this helps!
Guest
#80 Posted : Wednesday, November 7, 2018 12:10:54 PM(UTC)
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Hello! We are in Texas and we have a pt that was prescribe with an OAT. She has Medicare as primary insurance and UHC as secondary. We need guidance as how to submit her claim and how to get a pre authorization. We dont' want to risk getting denied.

Thanks!
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