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July 2016

Reminder: Procedure code E0485 not covered beginning Aug. 1

In alignment with Medicare’s policy, we’ll no longer pay for procedure code E0485 beginning Aug. 1, 2016. The code relates to a seldom-prescribed, pre-fabricated oral appliance.

We’ve been posting messages on web-DENIS about this coverage change since April.

Note: Federal Employee Program® and Michigan Public School Employees Retirement System members are excluded from this change.

A custom oral appliance may still be covered. We’ll provide more details in The Record in the near future.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.
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