Does Medicare Cover Oral Appliance Therapy?

Quick answer: Yes — Medicare Part B can cover a custom oral appliance for obstructive sleep apnea as durable medical equipment when its requirements are met: a sleep test that diagnoses OSA, an order from your treating physician, and a custom-made appliance. For more severe sleep apnea, Medicare may also require that CPAP was tried and not tolerated. Smiles for Life Dental Group works with Medicare for oral appliance therapy and checks your eligibility first.

How Medicare Coverage Typically Works

Medicare treats a custom oral appliance for sleep apnea as durable medical equipment under Part B, so it is billed through Medicare — not a dental plan (Original Medicare does not include routine dental coverage). The main requirements are a documented diagnosis of obstructive sleep apnea from a sleep test, a face-to-face evaluation and order from your treating physician, and a custom-fabricated appliance.

After you meet the Part B deductible, Medicare generally pays 80% of the approved amount; a Medigap supplement may cover some or all of the rest. Medicare Advantage plans follow their own rules and networks, and may need prior authorization — we check yours before treatment.

What We Handle for You

• Benefit verification — we confirm what your Medicare plan covers for oral appliance therapy before treatment starts.
• Referrals and authorizations — we check whether your plan needs a referral or prior authorization, and help get it in place.
• Sleep study coordination — if you have not been diagnosed, we coordinate testing with a sleep physician.
• Medical billing — oral appliance therapy is billed with medical codes, which we handle directly.

Why a Dental Sleep Medicine Diplomate Matters

Billing a medical plan for an oral appliance is a different process from routine dental care. As a Diplomate of the American Board of Dental Sleep Medicine, Dr. Pooja Goel has the training — and the experience with medical documentation — that this treatment requires.

Other plans we work with: Aetna, UnitedHealthcare, Kaiser Permanente, TRICARE, plus Sutter Health and the local IPAs PMG and SCCIPA.

Frequently Asked Questions