E0486 – Custom Fabricated Oral Appliance for OSA – Coding and Utilization Guidelines

Healthcare Common Procedure Coding System (HCPCS) Code E0486 describes a custom fabricated oral appliance used for the treatment of Obstructive Sleep Apnea (OSA).

E0486 – ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR NON-ADJUSTABLE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT

Effective for claims submitted on or after September 1, 2011, the only products that may be billed using code E0486 are those that have undergone Coding Verification Review by the Pricing, Data Analysis, and Coding (PDAC) Contractor and that are listed on DMECS in the Product Classification List which is located on the PDAC website, https://www.dmepdac.com/dmecsapp/.

Questions concerning the coding of these products should be referred to the PDAC, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/. For additional information about coverage, refer to the Oral Appliances for the Treatment of Obstructive Sleep Apnea LCD and policy Article.