Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Tuesday, July 5, 2011

Medicare Now Covers Oral Appliance Therapy

Beginning in January of this year, Medicare began funding the use of oral appliance therapy for the treatment of sleep apnea. This will allow seniors to get the sleep apnea treatment that is best suited for them, treatment that is comfortable, flexible, and effective. What's more, unlike many private insurance companies, Medicare does not require that you first attempt to use CPAP before seeking oral appliance therapy.

In order to get coverage for your oral appliance therapy, you must meet these criteria:

  • Have an evaluation by a treating physician prior to determine that you should be screened for obstructive sleep apnea
  • Your sleep test must find one of the following:
  • AHI or RDI of 15 events per hour with at least 30 events total
  • AHI or RDI of at least 5 with ten events total AND documentation of certain sleep apnea signs or symptoms
  • AHI or RDI >30, but you cannot tolerate CPAP or are otherwise not a good CPAP candidate
  • Your doctor orders the device
  • The device is provided and billed by a licensed dentist

In addition, not all oral appliances are covered. To meet the coding guidelines for coverage, oral appliances must:

  • Have a hinged or jointed mechanism
  • Be able to advance the mandible
  • Able to achieve mandible advancement beyond the front teeth
  • Be adjustable by you in increments of one millimeter
  • Be capable of retaining adjustment when removed

As a result, tongue positioning appliances are not covered.

We can help you understand which oral appliances meet the coding guidelines for coverage. To learn more, please schedule an appointment with a local sleep dentist today.

posted by Dr. Candelaria at 12:37 PM