The Pricing, Data Analysis, and Coding (PDAC) Contractor and each of the four Durable Medicare Equipment (DME) Medicare Administrative Contractors (MACs) have determined that the appropriate Medicare Healthcare Common Procedural Coding System (HCPCS) code to use when billing for SomnoMed’s SomnoDent product range is E0486.
In order to be designated code E0486, the oral appliance must be used to reduce upper airway collapsibility, be adjustable, and be custom fabricated. A custom-fabricated oral appliance is defined as one that is individually made for a specific patient.
“SomnoMed appreciates the timely decision made by PDAC and the DME MACs and especially those Centers for Medicare and Medicaid Services clinicians involved in reviewing SomnoMed’s evidence based application,” said Ralf Barschow, CEO of SomnoMed. “SomnoMed would also like to recognize the American Academy of Dental Sleep Medicine (AADSM) and American Academy of Sleep Medicine (AASM) for continuing to develop new standards of practice as well as the American Sleep Apnea Association (ASAA) for their continued dedication to inform and enhance the well-being of those affected by this chronic disease.”