Covered and Noncovered Services : Adjunctive General Services

Oral Devices/Appliances

An oral device/appliance reduces upper airway collapsibility and is used to treat sleep apnea.

ForwardHealth covers oral devices/appliances for members 20 years of age and younger with PA.

Coverage is limited to one oral device/appliance per year.

Allowable Procedure Code

Providers are required to indicate the fabrication and dispensing of oral devices/appliances using HCPCS procedure code E0486 (Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment) and modifier EP (Services provided as part of the EPSDT program) on all PA requests and claims.