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The doctor wants to know if you charge a fee for each time you use CPT99213? Also he want to know if you charge the fee for the sleep appliance at delivery? Edited by user Monday, February 11, 2013 5:40:00 PM(UTC)
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Hi jjsuppes!
Yes, most professionals will charge each time code 99213 is billed, as it stands for an established patient office visit. For sleep patients, some payors (like medicare) will include some E & M services in the reimbursement for E0486 (the oral appliance), like follow up office visits for 90 days after seating the appliance. This is called "global reimbursement", and if this is the case, you need not bill the office visit codes until the 90 days have past. Many insurers continue to pay separately, however.
And yes, since the oral appliance for OSA is Durable Medical Equipment, you want to bill the insurer for E0486 on the seat date, not the impression date (basically, DME needs to be DELIVERED to the patient before a claim is filed. Like when a patient gets a wheelchair.....the DME company will not file the claim with the insurer until the patient has received the wheelchair).
Hope this helps! Let us know if you have any additional questions!
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