Does Medicare cover oral devices for Sleep Apnea?

Sleep Apnea is a severe situation that impairs your body’s capacity to breathe while sleeping. The most common Sleep Apnea is Constructive Sleep Apnea (OSA). OSA is marked as periodic constriction and blockage of the pharyngeal airway during sleep. (Amal M Osman, Sophie G Carter, and Danny J Eckert, 2018)

Obstructive Sleep Apnea (OSA) is a significant worldwide health burden, with consequences for cardiometabolic health, productivity loss, chronic illness, and accident risk. (Kate Sutherland, Peter A. Cistulli , 2019) Continuous positive airway pressures (CPAP) and Oral appliances (OAs) are Sleep Apnea treatments. Oral appliances are created as an alternative to CPAP.

Moving forward, it is a frequently asked question “does Medicare cover oral devices for Sleep Apnea?” So today we have appeared with a quick answer to your question. Let’s go ahead.

Does Medicare cover sleep apnea oral appliances?

In order to minimize breathing blockages during sleeping, oral appliances (OAs) expand and stabilize the pharyngeal airway as an effective treatment for OSA. (Kate Sutherland, Peter A. Cistulli, 2019) Obstructive Sleep Apnea can be successfully treated with oral appliances, but the main concern is, does Medicare cover these devices? The quickest response is that Medicare will pay for oral appliances for Sleep Apnea. Although not always. The research concluded that, in contrast to CPAP, patients choose oral appliances and mandibular advancement devices, and these oral appliances can aid in the management of OSA. (Tahereh Hosseinzadeh Nik, 2011)

• As is frequently the case with Medicare, some requirements must be completed before Medicare will cover the cost of your dental appliances for Sleep Apnea.
• If your doctor prescribes a sleep study test, it is medically required to detect a disorder like Sleep Apnea, it is recorded and evaluated throughout the test, and Medicare Part B may fund it. But a sleep study for persistent insomnia won’t be covered by Medicare.
• Oral Sleep Apnea treatment devices are also covered by Medicare Part C. Along with other advantages, they provide coverage for everything Original Medicare does.

Furthermore, mothers told about the outcomes and advantages of frenectomy treatment in these words: (Nor Asilah Harun, Noor Arisa, Mohamad Rashidi, Nur Fadzilah, Md Teni, Yunita Dewi Ardini, Nurjasmine Aida Jamani, 2022)

• Speech, eating, and breastfeeding improvement. Research shows researchers discovered that lingual frenectomy increased speaking by 89%.(R. Baxter, R. Merkel-Walsh, N.R. Rendell, A. Lashley, B. Stark Baxter, 2020)
• Increase in weight.

Specific criteria to qualify for Medicare services

1. Before requesting coverage, the patient must visit a doctor, and a dentist must prescribe the device’s order. According to guidelines issued by the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM), patients experiencing symptoms of OSA must undergo a face-to-face examination by a sleep medicine physician for diagnosis purposes, and they prescribe oral appliances. (Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD., 2015)
2. A Medicare-approved sleep test is required for the patient to receive a Sleep Apnea treatment. The American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) recommended that sleep doctors perform follow-up sleep testing to improve or validate the treatment’s effectiveness. (Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD., 2015)
3. The oral device should meet all conditions specified in the criteria of durable medical equipment.
4. To be reimbursed, a dentist must be a Medicare DME Supplier.
5. Oral appliance therapy for treating OSA must be both essential and adequate. As stated in research, oral appliance treatment has turned into a significant replacement for continuous positive airway pressure (CPAP) in treating patients with obstructive Sleep Apnea syndrome.(Michiel H. J. Doff,Aarnoud Hoekema,Boudewijn Stegenga, 2013)
6. When the patient cannot tolerate a positive airway pressure device, or the physician thinks applying a CPAP machine in that circumstance would be useless.
7. Medicare will only pay for oral appliances that have suffered coding verification review by the PDAC Contractor.
8. Additionally, all other billing, coding, and documentation requirements must be met.

All crucial requirements must be met for Medicare to pay for your oral device. If all conditions are satisfied, Medicare Part B will cover 80% of the price of the oral appliance.

Specific criteria to qualify for Medicare services

CPAP is the first line of treatment for Sleep Apnea. (Brian Rotenberg,Claudio Vicini, 2016) A survey of 3,225 individuals treated with CPAP for obstructive Sleep Apnea in France. More than 80% of respondents said that CPAP therapy had considerably reduced their problems. (N. Meslier, T. Lebrun, V. Grillier-Lanoir, N. Rolland, C. Henderick, J-C. Sailly, J-L. Racineux)

Now, the answer to your concern about coverage of CPAP machines by Medicare is yes. Medicare insures your CPAP machine. Furthermore, they’ll include a regular plan for replacing equipment like masks, filters, hats, etc. Your CPAP machine is “durable medical equipment (DME),” which implies that Medicare Part B will pay for it.

Does Medicare cover alternative Sleep Apnea treatment?

Although CPAP is considered the best tool for treating Sleep Apnea, alternatives and options are still available when CPAC does not work or is suitable. It is necessary to have other therapy alternatives since there are people with mild but symptomatic diseases for whom CPAP is often unavailable or inappropriate. (Claire E. Francis & Tim Quinnell, 2020) Those alternatives are therapeutic (exercise, dietary control, and other lifestyle changes), surgical, and oral appliances.

1. In some instances, OSA surgery or oral appliance therapy can be effective.(Corina Budin, Lorena Ciumărnean,Anca Maierean,Ruxandra Râjnoveanu, 2019) Since blockages are typically found in the oropharynx, uvulopalatopharyngoplasty (UPPP) has been the most popular surgical treatment for OSA for over 25 years. (Tarabichi, 2021)
2. OSA patients may also benefit from other treatments, including oropharyngeal exercises, upper-way stimulation, and oral appliances (OA).(Corina Budin, Lorena Ciumărnean,Anca Maierean,Ruxandra Râjnoveanu, 2019)
3. “Mandibular advancement devices (MADs) are an efficient substitute for CPAP that can lessen symptoms during the day and enhance the quality of life. 96% of patients who wore the custom-made MAD had an AHI decrease of at least 50%, compared to just 64% of patients who wore the thermoplastic MAD. While wearing the ready-made MAD, 24% saw a normalizing.” (Claire E. Francis & Tim Quinnell, 2020)
4. Machines such as APAP and BiPAP.
5. Children’s mild to severe OSA is improved with intranasal corticosteroids. (W.J. Randerath, J. Verbraecken, S. Andreas, G. Bettega, A. Boudewyns, E. Hamans, F. Jalbert, J.R. Paoli, B. Sanner, I. Smith, B.A. Stuck, L. Lacassagne, M. Marklund, J.T. Maurer, J.L. Pepin, A. Valipour, T. Verse, I. Fietze, 2013)

MedsDental billing company is trustworthy for you to cover billing and to code the oral appliances for Sleep Apnea

Dentists and dental practices must keep a close watch on any legal modifications affecting oral appliances’ availability to ensure compliance with the law and receive payment for such appliances. As the Medicare coverage guidance and documentation requirements are constantly evolving and changing, it becomes overwhelming for a dentist to stay updated and adapt to the new rules. Therefore, MedsDental Dental Billing Company is there for you to reduce this burden.

We have a crew of experienced coders. They use valid codes for flawless billing so that Medicare will cover the oral appliances. Moreover, our professional billers are experts in the smooth billing process and pass your oral device through correct and quick coding. Our aim is not only the accuracy in billing but also to increase revenue for your dental practice; therefore, we have experienced workers for this purpose. Hire our company and gain multiple services and benefits from us. We implement up-to-date and reliable software and tools to improve the services and outcomes. Furthermore, as the safety of patient information and records is mandatory, we follow HIPAA rules and implement HIPAA-compliant services so that your practice can avoid penalties.