Dental billing best practices for sleep apnea procedures

August 2023
Greg Grobmyer, DDS

According to the American Medical Association, approximately 30 million people in the United States have sleep apnea. Sleep apnea has become more widely recognized as a life-damaging and potentially life-shortening disease, yet still only 20% of people suffering from sleep apnea are diagnosed and treated. That means 24 million people have yet to be diagnosed and treated for sleep apnea. The obvious need – combined with CDT coding for sleep apnea – indicates that more dentists will add sleep apnea treatment into their scope of services. If your dental practice is considering offering sleep apnea treatment to your patients, we’re here to walk you through the dental billing best practices for sleep apnea procedures.


What is sleep apnea?

Sleep apnea is a medical condition that is diagnosed and managed by a medical professional trained in the specialty of sleep medicine. Dentists, however, can be important partners in the treatment of sleep apnea.

Dental Technology with Confidence 2023 lists three types of sleep apnea:

  • Obstructive Sleep Apnea (OSA): The most common form of sleep apnea, caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.

  • Central Sleep Apnea: The airway is not blocked, rather the brain fails to signal the muscles to breathe, due to instability of the respiratory control center.

  • Complex Sleep Apnea: A combination of OSA and Central Sleep Apnea.


Sleep apnea may also be linked to other diseases, and recent studies have even shown a possible relation between the co-occurence of SIDS and sleep apnea.

There are many symptoms of sleep apnea, the most commonly known being snoring. But even when all symptoms are present, the only way to accurately diagnose sleep apnea is through an overnight sleep study. 


Dental billing for sleep apnea treatment

The most common sleep apnea treatment is the use of the positive airway pressure (PAP) machine. Many patient, however, are unable to tolerate weating the PAP mask, which leads to noncompliance.

Surgery is another option for patients. The most common surgery is the uvulopalatopharyngoplasty (UPPP), where soft tissue is removed from the back of the mouth and top of the throat. Other surgeries include advancement of the lower jaw, nasal surgery, and soft palate implants.

For patients that don’t like either of those options, there is a third: oral appliances. Oral appliances for the treatment of OSA have improved over the past few years and many dentists are now seeking advanced training in dental sleep medicine so they can effectively treat OSA in their community. 

Most major medical payors, including Medicare, now provide benefits for the treatment of OSA. Dental payors typically do not provide reimbursement since OSA is considered a medical condition. With that said, some PPOs may require a claim to be filed even if reimbursement is not expected. If so, report one of the following CDT codes:





Dental medical cross-coding for sleep apnea

When reporting sleep apnea appliances, Healthcare Common Procedure Coding Systen (HCPCS), commonly referred to as “hick-picks” codes, are utilized. These codes are more specific than CPT codes. There are two HCPCS codes for reporting a sleep apnea appliance:

  • E0485

  • E0486

The difference between these two HCPCS codes is very straightforward. One code describes an appliance that is custom-made by a laboratory, while the other describes a prefabricated appliance adjusted to fit by the dentist. With either code, some payors require the modified NU, indicating new equipment.


NOTE: Typically, payors do not reimburse for prefabricated appliances, but do not let that deter you from accurately reporting the type of appliance provided to the patient.

Dental billing & coding for your forward-thinking practice

Want to learn more dental billing and coding best practices for sleep apnea and other dental technology? Dental Technology with Confidence is the guide for you.  With this resource at your fingertips, you can feel confident in navigating the confusing world of insurance as it relates to technological advancements.

Grab yours today! You can also save 11% when you bundle it with any of our other dental coding and administration resources.

And did we mention that our resources are available as ebooks? CLICK HERE!


We also highly recommend Dental Zing’s Advanced Dental Billing on-demand CE course series.



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