PDAC Cleared List for K1027

Approved oral appliances used for billing Medicare and certain commercial insurers for custom made oral appliances for OSA

How to view the current PDAC cleared list:

Visit: https://www.dmepdac.com/

Click "DMECS" on the main page:

On the next screen select "Product Classification List", and type "K1027" into the field labeled "HCPCS Code", and click search:

The list of appliances will appear. Any appliance/manufacturer with a start date, but no end date is currently PDAC cleared! (However, if the appliance needs to follow PDAC guidelines K1027 would not apply).

**Please note that Medicare's policy still states the Oral appliance needs to have a fixed hinge, so if you bill the K1027 code it will be a denied service.

HCPCS code E0486 may only be used for custom fabricated mandibular advancement devices.  To be coded as E0486, custom fabricated mandibular advancement devices must meet ALL of the criteria below:

-Have a fixed mechanical hinge (see below) at the sides, front or palate: and

-Be able to protrude the individual beneficiary's mandible beyond the front teeth when adjusted to the maximum protrusion: and

-Incorporate a mechanism that allows the mandible to be easily advanced by the beneficiary in increments of 1mm or less: and

-Maintain the adjusted mouth position during sleep; and

-Remain fixed in place during sleep so as to prevent dislodging the device; and

-Require no return dental visits beyond the initial 90 day fitting and adjustment period to perform ongoing modification and adjustments in order to maintain effectiveness

*A fixed hinge is defined as a mechanical joint, containing an inseparable pivot point.  Interlocking flanges, tongue and groove mechanisms, hook and loop or hook and eye clasps, elastic straps or bands, mono-block articulation, traction-based articulation, compression-based articulation etc. (not all-inclusive) do not meet this requirement.

You can click the top of the "effective date" column twice to sort by that column to show most recently effective to oldest. Please make sure to check this site often as it is updated periodically.

As of 6/5/2024 the current approved list: