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May 26, 2011

Oral Appliance for OSA - E0486 Custom Fabricated - Coding and Utilization Guidelines

Oral Appliance for OSA - E0486 Custom Fabricated - Coding and Utilization Guidelines

Code E0486 describes a custom fabricated oral appliance used for the treatment of obstructive sleep apnea.

E0486 - ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR NON-ADJUSTABLE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT

Effective for claims submitted on or after September 1, 2011, the only products that may be billed using code E0486 are those that have undergone Coding Verification Review by the Pricing, Data Analysis, and Coding (PDAC) Contractor and that are listed in the DMECS Product Classification List on the PDAC website.

Questions concerning the coding of these products should be referred to the PDAC. For additional information about coverage, refer to the Oral Appliances for the Treatment of Obstructive Sleep Apnea LCD and policy ArticleExternal Website.

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