Policy Statement
Custom oral appliances (E0486) are eligible for reimbursement only when provided and billed by a licensed dentist (DDS, DMD) with a valid and current order from the treating physician. Medical Records may be requested for review at any time.
All care, including fitting, adjustments, modifications and associated professional services required the day of provision or during the first 90 days after provision of the oral appliance are included in the payment for device. Claims for these will be denied as not separately payable.
Custom oral appliances are eligible for replacement at the end of the 5-year reasonable useful lifetime.
References
Cross References
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