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Provider Manual

Services related to oral appliances – for treatment of obstructive sleep apnea

Last Updated on August 28, 2018

Important notice for dentists and oral surgeons regarding coverage for services related to oral appliances for the treatment of obstructive sleep apnea.

Effective January 1, 2016, Security Health Plan is updating how follow-up services for members with an oral appliance will be covered under member policies for Security Health Plan Commercial, Medicare Advantage and the Secure Saver Medicare Savings Account products.

Security Health Plan follows 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. 

Effective for dates of service on and after January 1, 2016:

  • 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 October 2015.