Ann answers your questions - How can I bill insurances for apnea device for my patients?

Dear Dr. Cole,

Thank you for your question concerning billing for sleep apnea devices.  That is a growing concern among dentists who fabricate these appliances.

You are correct---obstructive sleep apnea appliances are not typically a covered dental benefit and should, therefore, be billed to the patient’s medical insurance plan.  If, however,  you choose to file with a patient’s dental insurance, use code D5999, Unspecified Maxillofacial Prosthesis, by Report, and include your diagnosis and treatment plan with the claim. 

You mention you have been trying to bill medical plans for these devices, but are having difficulty doing so which must mean you are not receiving payment.  Most medical plans will not reimburse a dentist for these devices unless the claim is accompanied by a medical diagnosis including a sleep study for that particular patient.

Due to these cumbersome restrictions, many dentists choose to bill the patient for sleep apnea devices.  I suggest you calculate a fair fee for the device and present it to the patient as just that---a fair fee for a device that will greatly enhance their sleep patterns and, therefore, their overall health.  Inform them about the need for a medical diagnosis and sleep study if the claim is to be filed with their medical insurance.  Make it clear to each patient needing a sleep appliance that you try to help patients by billing both their dental insurance and medical insurance plans; but so far, you have not received payment from either type of plan.

Most CDT 2016 advisory guidebooks state that snoring is generally considered neither a dental nor a medical problem and, therefore, cannot be billed to either type of plan.  One guidebook even states that snoring is a social issue.  Interesting!  Therefore, I think you should bill patients for whom you fabricate snore guards with no mention of filing insurance unless the patient requests you do so.  Then you can explain that the fee for anti-snoring appliances are not reimbursed by either dental or medical insurance.

In researching new information to help answer your question, I came across a website that you may want to visit---www.sleepcomplete.com which has a byline, Sleep Complete, Dental Sleep Medicine Program.  Additionally, I suggest you contact the American Dental Association to ask if the Code Maintenance Committee which takes suggestions for code changes and additions until November 1 of each year has sleep apnea appliances on its list of suggested changes for 2017 codes.  If a sufficient number of you practicing dentists ask the ADA Code Maintenance Committee to propose an additional code for 2017, perhaps dental insurance carriers can be pressured into covering this service.  The ADA has the collective clout of all you practitioners and may well be the only organization powerful enough to demand an answer to this problem.

Thank you for your question and your interest.  We appreciate your considering Practicon among your favorite dental suppliers as evidenced by your orders, and we look forward to providing world-class products and service to you and your staff for many years to come.

Ann Page Griffin