August 17, 2017
Dental providers often have questions about submitting claims for oral appliances used in sleep apnea treatment. Here are three key points to know:
- Claims for sleep apnea must be billed on a CMS-1500 form (medical claim form) and cannot be billed on a dental claim form. For assistance with submitting a CMS-1500 claim form, see our Provider Reference Manual, Claims and Payment section.
- A diagnosis code is required to process the claim.
- Review the Healthcare Common Procedure Coding System (HCPCS) codebook to identify a procedure code that most accurately represents the oral appliance that you provided to the member.
For more information on coding with HCPCS codes, contact your professional association.