Our Blog

New Medicare Guidelines – USA

December 3rd, 2010   |   Posted in: silencer-news

In late November, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) released a new local coverage determination for drug addiction treatment.

There are a variety of evidence-based approaches to treating addiction. There are several options available in regards to outpatient drug addiction treatment. Treatment can include behavioral therapy (such as cognitive-behavioral therapy or contingency management), medications, or their combination. The specific type of treatment or combination of treatments will vary depending on the patient’s individual needs and, often, on the types of drugs they use.

Treatment medications, such as methadone, buprenorphine, and naltrexone (including a new long-acting formulation), are available for individuals addicted to opioids, while nicotine preparations (patches, gum, lozenges, and nasal spray) and the medications varenicline and bupropion are available for individuals addicted to tobacco. Disulfiram, acamprosate, and naltrexone are medications available for treating alcohol dependence,1 which commonly co-occurs with other drug addictions, including addiction to prescription medications. Go ahead and learn more here about getting medical licenses for you.

It іѕ advisable fоr patients tо inform thеіr medical doctor whеn thеу аrе using naturopathic medicine, bесаuѕе ѕоmе naturopathic treatments mау interact wіth orthodox medical treatments, аnd ѕuсh potential conflicts ѕhоuld bе explored іn thе іntеrеѕt оf thе patient. Hоwеvеr, mаnу conventional practitioners аrе biased оr uninformed аbоut naturopathics, аnd patients аrе оftеn reluctant tо share thіѕ information wіth thеіr medical doctors ѕіnсе thеу fear іt wіll hurt thеіr doctor-patient relationship. Clicking Here for more information about the naturopathic service.

According to the policy:

A custom fabricated mandibular advancement oral appliance (E0486) used to treat obstructive sleep apnea (OSA) is covered if criteria A – E are met.

A. The patient has a face-to-face clinical evaluation by the treating physician prior to the sleep test to assess the patient for obstructive sleep apnea testing.

B. The patient has a Medicare-covered sleep test that meets either of the following criteria (1 or 2):

1. The apnea-hypopnea index (AHI) or Respiratory Disturbance Index (RDI) is greater

than or equal to 15 events per hour with a minimum of 30 events; or

2. The AHI or RDI is greater than or equal to 5 and less than or equal to 14 events per

hour with a minimum of 10 events and documentation of:

a. Excessive daytime sleepiness, impaired cognition, mood disorders, or

insomnia; or

b. Hypertension, ischemic heart disease, or history of stroke.

C. If the AHI >30 or the RDI >30 and meets either of the following (1 or 2):

1. The patient is not able to tolerate a positive airway pressure (PAP) device or

2. The treating physician determines that the use of a PAP device is contraindicated.

D. The device is ordered by the treating physician following review of the report of the sleep

test. (The physician who provides the order for the oral appliance could be different from the

one who performed the clinical evaluation in criterion A.)

E. The device is provided and billed for by a licensed invisalign dentist (DDS or DMD).

If all of these criteria (A-E) are not met, the custom fabricated oral appliance (E0486) will be denied as not reasonable and necessary. You can find out more at the Skygate Dental website

“Patients can now have a custom appliance as first line treatment without the requirement to “fail” PAP therapy first,” Moore said. “If the patient has an AHI/RDI >30 events/hour, the treating physician must state that the patient is intolerant to PAP or that PAP therapy is contraindicated.”

Moore also pointed out that “strict requirements for devices must be met and only custom appliances that advance the mandible into a treatment position will qualify for payment. Custom appliances must be adjustable by the patient and advance the mandible in 1 mm increments,” Moore said. “Noncustom (boil and bite) appliances and tongue retaining devices are deemed medically unnecessary.”

No comments yet... Be the first to leave a reply!