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Medicare Guidelines

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Tia +0 points · over 2 years ago Original Poster

Hello! I had a sleep study done in 2009 and wore a C-Pap mask for several years. I then transitioned to an oral device. I want to have a new one made, and am new to the world of Medicare. I have verified that the device is Medicare-approved and that the dentists I am speaking to are Medicare-certified. However - one dental office said that a class she attended just yesterday told the staff that I need to have a new sleep study done if mine is more than 12 months old; the other office (I spoke to their Medicare biller) said that's not necessary. Called Medicare directly and they said that as long as I have a sleep study (not date-dependent) and prescription I am good to go. Anybody have any feedback out there?

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wiredgeorge +0 points · over 2 years ago Sleep Enthusiast

Physiology changes over time; I suspect that it would be a great idea to have another sleep study to get a good baseline for the new appliance going forward into the future. You can read medicare guidelines online and that would likely be more help than asking folks on a forum OR you could ask a sleep dentist if he would recommend a new study and if he believed medicare would foot the bill and then have the new appliance made from there. Just too much time has passed, in my amateur opinion, for a 9 year old sleep study to be the basis for any new treatment option.

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Bigmike52 +0 points · over 2 years ago

I would agree with wiredgeorge. Due to retiring to another state, I was required to get a 2nd. sleep study within 13 months due to some Obamacare issues between the states. To my surprise, the latter sleep study was higher than the first. If it changed in only one year, it's possible yours changed in 9 years.

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