Medicare PDAC oral devices for sleep apnea

Oral sleep appliances can play a vital role in helping those who struggle with issues such as sleep apnea and snoring. As your provider of oral sleep appliances, Santa Cruz’s Spark Sleep Solutions offers a variety of oral devices that can assist in treating these problems to help you achieve a better night’s sleep. However, if you are working with Medicare, there are some additional requirements you may need to pay attention to.

Medicare requires oral devices to be PDAC approved to be considered for coverage. But what is PDAC approval and what requirements must a device meet?

What is PDAC Approval?

The Pricing, Data Analysis, and Coding (PDAC) process allow for devices to be reviewed and approved for the Health Care Procedure Coding System (HCPCS), which are standardized codes used to process health insurance claims and be considered Durable Medical Equipment (DME). Herbst and TAP appliances are two common oral appliances that fall into this category.

Herbst Appliance

An Herbst appliance is a small oral appliance that can be used to treat sleep apnea. Obstructive sleep apnea is a potentially dangerous sleep condition caused by muscles that support your throat’s soft tissue relaxing and narrowing your airway. This leads to disrupted breathing throughout the night while sleeping.

Similar to a retainer, an Herbst appliance is a removable liner that fits over the teeth of the upper and lower jaw, with adjustable positioners on each side of the mouth. This appliance is worn during sleep to help modify jaw positioning. By bringing the lower jaw forward, the muscle and tissue tighten, keeping your airway open during sleep.

TAP Appliance

A Thornton Adjustable Positioner (TAP) appliance is another oral appliance for treating obstructive sleep apnea and snoring. Similar to an Herbst, a TAP appliance resembles a retainer with upper and lower jaw pieces, however, they are connected by a fixed hinge point which helps hold the lower jaw slightly open and pulled forward. This positioning also brings the tongue forward and helps keep your airway open while asleep.

Device Requirements for Approval

Currently, there are a few requirements that must be met before an appliance can be considered for PDAC approval including:

  • a fixed mechanical hinge must be on the side, front, or the palate
  • must allow for the lower jaw to be adjusted in increments of 1mm or less
  • must maintain the set adjustment when removed
  • must maintain the position of the mouth in sleep to prevent the appliance from dislodging

To learn more about the full requirements, we encourage you to talk to a Medicare representative or you can speak with your trusted Santa Cruz oral appliance therapy provider.

Your Choice for Santa Cruz Oral Appliance Therapy

If you often wake up fatigued, with a headache, or have been told you snore or gasp for breath in your sleep, then you may suffer from sleep apnea. If left untreated, sleep apnea can have devastating effects on your overall health and wellbeing. As your trusted provider of oral sleep appliances in Santa Cruz, Spark Sleep Solutions has several convenient locations that provide sleep apnea testing and diagnosis. Let us help you achieve a healthier night’s sleep – contact us today to learn more or to schedule your appointment.