Local Coverage Determination · DME MAC
L33611
Oral Appliances for Obstructive Sleep Apnea
Version 25. CMS effective date 08/08/2021. CMS updated 06/18/2021. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. A custom fabricated mandibular advancement oral appliance (E0486) used to treat obstructive sleep apnea (OSA) is covered if criteria A - D are met. The beneficiary has an in-person clinical evaluation by the treating practitioner prior to the sleep test to assess the beneficiary for obstructive sleep apnea testing. Refer to the ICD-10 code list in the LCD-related Policy Article for applicable diagnoses.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A52512 · Oral Appliances for Obstructive Sleep Apnea - Policy Article
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A58823 · Response to Comments: Oral Appliances for Obstructive Sleep Apnea – DL33611
HCPCS codes on this LCD
2 other Level II codes are on the LCD and are not given a page in this set: E0486, E1399.
Questions
What does LCD L33611 cover?
L33611 is Oral Appliances for Obstructive Sleep Apnea. It is a current final DME MAC local coverage determination, version 25.
Where is the CMS source for L33611?
The Medicare Coverage Database page for LCD L33611 version 25.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=A9270&as_of=2024-01-15&npi=1234567890&state=UT"