Question 1

What is HCPCS code E0485?

Accepted Answer

HCPCS code E0485 is "Oral device/appliance prefab". Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment

Question 2

What category is E0485 in?

Accepted Answer

E0485 belongs to HCPCS Category E (Durable Medical Equipment (DME)).

Question 3

When should I use HCPCS code E0485?

Accepted Answer

Use E0485 when billing for oral device/appliance prefab. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is E0485 covered by Medicare?

Accepted Answer

Coverage for E0485 (Oral device/appliance prefab) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for E0485?

Accepted Answer

Documentation for E0485 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).