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Product Overview D-SNP
Services related to oral appliances - for treatment of obstructive sleep apnea
Last Updated on January 09, 2023
Important notice for dentists and oral surgeons regarding coverage for services related to oral appliances for the treatment of obstructive sleep apnea.
Security Health Plan follows Centers for Medicare and Medicaid Services (CMS) standards of coverage for services relating to oral appliances for the treatment of obstructive sleep apnea.
Per confirmation with CMS, coverage guidelines dictate payment for all care associated with the oral appliance dispensed for obstructive sleep apnea is included in the reimbursement for the device. Specifically, “all care” is defined as the initial visit, fitting, adjustments, modifications, home sleep studies and all other professional services. Claims for these professional services will be denied as not separately payable.
- Security Health Plan will deny all care prior to, the same day as, or within 90 days after delivery of the oral appliance, as provider responsibility.
- Security Health Plan will deny any follow-up services with a dentist or oral surgeon, related to oral appliances that are greater than 90 days after the delivery of an oral appliance, as member responsibility.
CMS standards of coverage for services relating to oral appliances can be found in CMS Local Coverage Article A52512 (Oral Appliances for Obstructive Sleep Apnea) dated August 8, 2021.