Cost and Insurance

Obstructive Sleep Apnea (OSA) is a medical condition. Since dentists do not participate in medical insurance plans, your treatment will be considered out of network. You will file for medical insurance instead of dental. All fees for office visits, diagnostics, treatments and follow up appointments are payable directly to our office at the time of service and we will help you get reimbursement.

We will help you get the maximum benefit available to you through your medical insurance. Your claims will be processed promptly so you will be reimbursed in a timely manner. The insurance payments will be made directly to you as the subscriber.

Mandibular Advancement Splints (MAS) for the treatment of Obstructive Sleep Apnea normally fall under the standard benefits of insurance policies; however it is possible for the devices to be covered under durable medical equipment and prostheses. You will need the following items:
1.	A copy of the patient’s Polysomnogram (sleep study) confirming diagnosis
2.	A Letter of Medical Necessity from the primary care physician or sleep specialist
3.	A report from our dental office describing symptoms, diagnosis, and treatment

The following items are required for submitting a medical claim to an insurance company
1.	Medical claim form with:
a.	ICD Medical Diagnosis Code: 327.23 Obstructive Sleep Apnea 780.57 Upper Airway Resistance Syndrome
b.	Treatment Code: E0486 Custom fabricated, adjustable / non-adjustable oral appliance to prevent airway collapsibility or;
c.	Treatment Code: E0485 Temporary non-adjustable, prefabricated appliance to prevent airway collapsibility
2.	Letter of Medical Necessity from the primary care physician or sleep specialist. This letter should recommend MAS Therapy for the patient.
3.	Copy of the patient’s Polysomnogram (sleep study) confirming diagnosis.
4.	Letter from the dentist describing the patient’s symptoms, diagnosis, what type of appliance that you are using and how it works.
5.	Copy of the Practice Parameters report by the AASM that was released in 2006 recommending Oral Appliance use for mild and moderate sleep apnea and those severe cases that cannot tolerate CPAP.

Please note all insurance companies are different and may recognize different codes or request additional information. Some medical insurance carriers will require that patients with moderate to severe OSA try CPAP prior to an oral appliance. Patients with mild OSA and those intolerant to or who refuse to wear CPAP may be considered immediately for MAS therapy. If the patient is unable to wear a CPAP please ensure the Letter of Medical Necessity states this.

The above are guidelines to help you understand the financial responsibilities to our office and information for your medical insurance. Some patients find it helpful to contact their insurance company prior to care to find out if the procedure is a covered service. Your insurance company may ask for the ICD codes above.

Please talk with Joann who will help you with fees and insurance questions.


Snoring and Sleep Apnea can be managed with the CPAP alternative!
Call Philadelphia Dental Sleep Medicine now to help with healthier sleeping!
215-735-8844