Oral Appliances for Sleep Apnea Treatment

Blue Cross and Blue Shield of Nebraska (BCBSNE) medical policy for treatment of obstructive sleep apnea (OSA) includes an oral appliance, among other alternatives. Treatment of sleep apnea must be preauthorized for BCBSNE members, or the claim will be denied as provider liability. 

Because dentists are best qualified for evaluating a patient’s suitability for the mouthpiece and making the dental impressions, BCBSNE regulates the coding guidelines that dentists are to bill for the oral appliance. 

As with any medical service rendered by a dentist, BCBSNE requires CDT Dental Procedure Codes on the NEtwork BLUE dental fee schedule to be billed on the medical claim. 

Oral sleep devices should be billed under E0486. This code includes fitting and adjustments. Any related services such as x-rays, impressions and morning aligner are included in E0486 and should not be billed separately.
 
The medical policy for sleep apnea treatment is VIII.8 “Medical Management for Obstructive Sleep Apnea” available at MedicalPolicy.NebraskaBlue.com.