Dentists Must Enroll as DMEPOS Suppliers for Medicare to Pay for Their Oral Appliances

CMS-855S is application form.

By Sree Roy

For general dentists who are interested in adding dental sleep medicine services for patients who are Medicare beneficiaries, a commonly asked question is: Will Medicare pay for oral appliance therapy for obstructive sleep apnea? The answer is yes, as long as all of Medicare’s requirements are met.

What surprises some dental sleep medicine novices is that to receive Medicare reimbursement for oral appliances, dentists must first enroll as durable medical equipment suppliers—commonly known as a DMEs, though Medicare refers to these suppliers as “DMEPOS” supplies (which stands for “durable medical equipment, prosthetics, orthotics, and supplies”). So in this sense, a dentist is in the same category as a wheelchair supplier.

To enroll, the dentist must complete form CMS-855S. Medicare has about 30 standards that a Medicare DMEPOS supplier must meet in order to obtain and retain their billing privileges. Examples include “A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare covered items that are under warranty” and “A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine, answering service or cell phone during posted business hours is prohibited.” A summary of all of the standards is available on form CMS-855S. These standards, as well as the following of all other Medicare rules and related laws, must be maintained for the duration of the supplying of oral appliance therapy to Medicare beneficiaries, otherwise the dentist-supplier is at significant risk during an audit.

Though the standards are rigorous, many dentists all over the United States successfully receive payment for oral appliances from Medicare, allowing them to help these patients comply with OSA therapy. To learn more, visit www.cms.gov.