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Should you bill your patient’s medical insurance on delivery or impressions for oral appliances for OSA?

Billing patient's insurance from date of delivery of appliance


Should you bill your patient’s medical insurance on delivery or impressions for oral appliances for OSA?


This is a common question for dental practices who are new to Dental Sleep Medicine and providing oral appliances for Obstructive Sleep Apnea.


The Answer: The day the oral appliance is delivered to the patient!


Why not on the date of impressions & bite registration?
Oral appliances for OSA are classified as Durable Medical Equipment (DME), and such equipment should not be billed to the insurer until it is in the patient’s possession.


For example, one of the documentation requirements for the oral appliances for OSA (HCPCS code E0486) for Medicare is a “proof of delivery”. The LCD (medical policy) for Medicare states:
“Proof of delivery (POD) is a Supplier Standard and DMEPOS suppliers are required to maintain POD documentation in their files. For medical review purposes, POD serves to assist in determining correct coding and billing information for claims submitted for Medicare reimbursement. Regardless of the method of delivery, the contractor must be able to determine from delivery documentation that the supplier properly coded the item(s), that the item(s) delivered are the same item(s) submitted for Medicare reimbursement and that the item(s) are intended for, and received by, a specific Medicare beneficiary."