Oral Appliance Therapy & Medicare

Oral Appliance Therapy is ideal for sleep apnea patients that have Medicare coverage and are without treatment or intolerant of CPAP therapy. As a Dentist that accepts Medicare, below are some of the top Medicare Approved Oral Appliances on the market.

SOMNODENT
HERBST ADVANCE®

Comfortable for Patients With Smaller Mouths

Visual Calibration Indicator – Ideal for Medicare Population to See Appliance Settings

Medicare and PDAC Verified Oral Appliance

SOMNODENT
SUADTM

Casted Frame and Substructure for Added Strength

Non-restrictive But Ideal for Bruxism Patients

Medicare and PDAC Verified Oral Appliance

Not a Medicare Provider? We have resources to get you on your way.

Medicare Approved Oral Appliances

HERBST ADVANCE®

Herbst Advance SomnoDent

E0486 Medicare & PDAC Verified

Comfortable for a smaller mouth

Visual Calibration Indicator for Ease of Titration

Less Resets with 8mm Range of Calibration

Available with Soft SMH BFlex Lining or Ball Clasp Retention

3 Year Product Warranty – Manufacturers

FDA 510(k) Cleared

Manufactured Under 21 CFR 820 and ISO 13485 Standards

PRICING:

All-Inclusive Pricing & Free Add-Ons
Dentists, Call Now for Pricing: 888-309-1065

E0486 Medicare & PDAC Verified

Casted Frame that Traces Arches, Creating Strength

Unlimited Protrusive Advancement

Non-restrictive in Movement, Allowing Patient to Open and Close Mouth

Available with Soft SMH BFlex Lining, Ball Clasp, or Acrylic Retention

3 Year Product Warranty – Manufacturers

FDA 510(k) Cleared

Manufactured Under 21 CFR 820 and ISO 13485 Standards

PRICING:

All-Inclusive Pricing & Free Add-Ons
Dentists, Call Now for Pricing: 888-309-1065

SomnoMed
Medical Billing Series

Medical billing is one of the main challenges to master for dental practices initiating a sleep protocol. From managing new dental sleep processes to training staff on how to screen and schedule patients – you have more than enough to do to manage your practice. 

You can access Medical Billing information and practice resources by completing the form below and a dedicated representative will call you with more information.

Frequently Asked Questions

”Are SomnoMed devices PDAC approved?

Not all oral appliances are created equal. Medicare only covers the ones listed on their approved PDAC list. Most recently, this list was restricted to a couple dozen different appliance variations, of which several were SomnoMed appliances.

Other examples of oral appliances covered include those that involve a fixed mechanical hinge, such as designs that mimic a TAP or Herbst appliance. As such, they can be adjusted yet fit securely when the patient sleeps.

SomnoDent Herbst PDAC Letter (August 2013)

SomnoDent Herbst Advance PDAC Letter (September 2014)

SomnoDent SUAD PDAC Letter (November 2011)

”Do I have to become a DME Provider?

Yes, in order to bill a patient’s oral appliance toward Medicare, you must be a contracted Medicare DME (Durable Medical Equipment) provider. Yes, oral appliances are included in the same category as wheelchairs! (Without this approval, you can’t file claims for the service.)

”What is the Medicare policy for oral appliance therapy for Sleep Apnea?

Medicare has two separate contracted groups; physicians and other medical providers contracted under the area of medical services. Companies that actually sell medical goods, such as CPAP machines, wheelchairs and nebulizers have a DME contract.
Medicare has a very strict medical policy for coverage of oral appliance therapy.

1. They have a different definition of obstructive sleep apnea and it is more stringent than commercial insurance companies.
2. They require a prescription from the patient’s physician that requests the dentist to make an oral orthotic.
3. Medicare will hold a deductible and co-insurance that will be the patient’s responsibility.
4. Expect Medicare to deny coverage the first time all of the paperwork is filed. Appealing their decision is standard operating procedure.
5. Many supplemental insurances will cover the deductible and co-insurance.

”Can I file for reimbursement on behalf of my patients?”

Yes, you can file for direct Medicare reimbursement on behalf of your patient. Be sure to reference the information provided in our billing course. Because you are working with medical claims, there are different modifiers codes that must be used when Medicare is involved than those used for traditional medical claims.

”Do I have to prove grounds for sleep therapy?”

You and your patient need to prove that oral appliance therapy (OAT) is medically necessary. This would include documentation of pain, past accidents, damage caused by infection, or dysfunction of the airway. If you have this information, you can file a claim directly to Medicare, assuming your patient qualifies. Lack of documentation (evidence) may result in a rejected claim. Remember the first rule you learned in dental school: document, document, document!

How can I get started with my first case?

A: You can click here to access the case order form; however, we recommend you start by calling us at 888-309-1065  in order to cover any questions or concerns you may have.

”How can I learn more about billing Medicare for oral appliance therapy?”

As a dentist, SomnoMed equips you with resources that enable you to learn the skills necessary to begin practicing and billing for dental sleep medicine within your practice. That includes filing claims toward coverage for patients on Medicare, and even which forms to fill out.

Don’t see your question listed here?

Medicare Approved Oral Appliance Reviews

boardman
”It is well-made, durable, and well fitting. SomnoMed, the company that produces the Herbst Advance, stands by this product and had been excellent. The Herbst Advance is made so insertions have little to no adjustments at chairside. The scale (VC) is extremely helpful in assessing the protrusive position.”

– Warren Boardman,DMD Ridgewood, NJ

erika
”SomnoMed makes such high-quality devices that the fit of the Herbst Advance is very good. The SomnoDent Herbst Advance is especially comfortable, easy to adjust, and affordable. Also, the fit of the Herbst Advanced is very good, without the need for much adjustment; which makes for happier patients.”

– Erika Mason, DDS, D-ABDSM, D-ACSDD Midlothian, VA

gershberg
”Sleep Apnea treatment has become more than 50% of my practice, It is an excellent product that did exactly what I needed it to do. I can’t afford to spend hours with the patients making fit adjustments and I need an appliance that is easy and quick to adjust. This appliance fit the bill. Because of initial patient comfort. It decreased the amount of time it took patients to get used to wearing, and we achieve success quicker.”

– Stephen J. Gershberg, DMD; Bryn Mawr, PA

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