New billing guides: E0486
Effective October 1, 2023, Blue Cross Blue Shield of Kansas (BCBSKS) will reimburse for sleep apnea dental appliances (E0486) under a global concept.
When billing for sleep apnea dentistry, a low-level E/M for the initial evaluation (99202- 99203 new patient or 99212-99213 established patient) should be used. If billing anything higher, make sure the documentation supports the use of the higher-level E/M code. Bill E0486 for the appliance itself (which includes the fitting and adjustments). BCBSKS will also use code E0486 to bundle any X-Rays, impressions and AM aligners. The bundled services should not be billed separately.
Any follow up visit within the first 42 days of receiving the appliance will also be considered content of service to the E0486. After the initial 42 days have passed, the dentist may bill a follow-up visit (low level E/M 99212-99213) if it is medically necessary.
If you have any questions regarding the new coding for sleep apnea dental services, please contact your Professional Relations Representative.