What to Bill
Dental Practices can bill a variety of procedures to a patient’s medical insurance including CT scans and X-rays, TMD splints and treatments, extractions, and implants, in addition to many others. Of course, coverage will always depend on the patient’s individual plan, and we are happy to investigate any billing that you wish to try.
By far, the claims we work on most often are related to treating sleep apnea, and there are generally two claims, the appliance and office visits.
- Office Visits
Any time that you are discussing or treating a medical condition, such as sleep apnea, you can submit the bill for the office visit to the patient’s medical insurance. There are a many different office visit codes, and we are happy to help you choose the correct one. They vary based on the complexity of the issue you are dealing with, the amount of time spent with the patient and how the patient was referred to your office. Reimbursement for office visits can span from around $25 dollars to $400 depending on the code and the insurance.
- Oral Appliance
Once the patient actually receives the oral appliance (Seat Date) you can submit a claim for that appliance to the medical insurance. The insurance will generally also require a copy of the sleep study and chart notes from your office visits to be included with the OA claim. Reimbursement for oral appliance varies greatly as well. Medicare pays around $1,200, which includes the appliance and follow up adjustments. Private insurance reimbursement is generally higher and pays separately for the appliance and any other encounters.
Different insurance companies will approve different appliances, but as a general rule, the appliance must be:
Custom Made for the Patient (not boil and bite)
Adjustable
FDA Approved for Sleep Apnea Treatment (not just snoring)
The major appliances such as the Herbst, Tap, SomnoDent, Respire and EMA are approved by all insurance companies, but they are not all appropriate for every patient. If you need more guidance on appliances, we are happy to help, but we also recommend contacting the Appliance Experts at Gergen’s Orthodontic Lab.