Audience: Participating Dental Care Providers
Your participating dental provider contract with Excellus BlueCross BlueShield includes participation for oral sleep apnea treatment. Please review the important information below related to HCPCS code E0486, oral sleep apnea appliance, and share it with anyone in your practice who should be aware.
Authorization Requirement
- Effective May 1, 2022, preauthorization will be required for E0486 for commercial and Medicare members. To request preauthorization, please contact Customer Care at 1-800-363-4658.
Medicare Advantage
- E0486 is considered a basic medical benefit under Medicare. If you have opted out of Medicare, Excellus BCBS is not permitted to pay for basic medical benefits for Medicare Advantage members.
- We encourage you to remove your opt-out status as soon as you are eligible. Review your opt-out status at: https://data.cms.gov/provider-characteristics/medicare-provider-supplier-enrollment/opt-out-affidavits
Medicaid Managed Care, Child Health Plus, Healthy NY, Essential Plan
- E0486 is not covered for members with Medicaid Managed Care (including the Health and Recovery Plan, or HARP), Child Health Plus, Healthy NY or Essential Plan coverage.
- Please check the Medicaid eligibility verification system, eMedNY.org, for Medicaid Managed Care member benefits and eligibility.
Oral sleep apnea claims need to be submitted on a medical claim form. Review our Navigating the Blues Dental Guidebook on our Dental Resources page, for more information.
Thank you for the quality care and service that you provide to our valued members.
