Medical HCPCS code for dental practice to use when billing medical insurance for custom made oral appliances for Obstructive Sleep Apnea (OSA) and snoringThere are two codes to choose from when coding for oral appliances being used to treat snoring and Obstructive Sleep Apnea (OSA), E0486 and E0485.
E0486 is commonly covered by medical insurance for patients who meet criteria. E0485 is commonly not covered, although there are exceptions. E0486 is for custom made appliances, while E0485 is for pre-fabricated appliances. Below are the full descriptions of each:
E0486: Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment
E0485: Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment
Keep in mind, whether the device is being used to treatment snoring only or OSA, the code for the appliance remains the same. The difference on the claim for snoring vs. OSA will be the diagnosis (ICD-10) code. Please note many insurers state that treatment of snoring alone is not considered medically necessary, while treatment of diagnosed OSA is.