More dental practices are adding sleep apnea treatment to their services—and for good reason. Oral appliance therapy can be life-changing for patients. But when it comes to billing, many practices find themselves overwhelmed.
From high-cost startup programs to limited training at industry events, the process for billing sleep services is often unclear. Even major institutions like the University of Michigan now teach that these services fall under medical insurance protocols—but most dental offices aren’t built to handle medical billing effectively.
At Insurance Billing Experts, we’ve spent over a decade helping practices manage this complexity. Here’s what you need to know to avoid costly mistakes and ensure your sleep services are reimbursed correctly.
Where Most Sleep Billing Breaks Down
Many practices invest thousands of dollars in courses, software, or third-party vendors promising quick setups—but are left without the infrastructure needed to bill accurately.
Common problems include:
- No established verification of benefits (VOB) process
- Missing or incomplete diagnosis documentation
- Failure to obtain prior authorizations
- Incorrect use of procedure codes
- Lack of clarity on medical vs dental submission paths
- Teams who haven’t been trained in medical claims workflows
These issues often lead to denials, delays, or underpayments—hurting both revenue and patient trust.
The Fundamentals of Sleep Apnea Billing
Treating obstructive sleep apnea with an oral appliance is typically classified as a medical procedure, not dental. As a result:
- Medical insurance is usually the primary payer
- Accurate diagnosis and documentation are required
- Most cases need prior authorization, especially under Medicare or commercial plans
- Payer policies vary significantly in what they require and reimburse
This adds complexity that most dental billing systems weren’t designed to handle.
Six Key Steps to Improve Sleep Billing Outcomes
- Verify Benefits the Right Way
Avoid relying on phone calls or surface-level VOBs. A thorough, written verification is essential—outlining coverage, medical necessity requirements, and pre-auth instructions. - Understand Procedure Coding
Each oral appliance must be billed using the appropriate HCPCS codes, which differ based on device type and insurance plan. Incorrect coding leads to instant denial. - Determine When to Bill Medical vs Dental
Some cases qualify for medical billing, while others must remain on the dental side. Knowing when to switch—and what documentation supports it—is critical for approval. - Prepare Complete Documentation
At a minimum, you’ll need a sleep study, diagnosis from a physician, and detailed clinical notes supporting the prescribed appliance. Missing information is the top reason for denials. - Prioritize Pre-Authorization
Most carriers require pre-authorization for oral appliance therapy. That process typically involves several documents: diagnosis, clinical notes, and letters of medical necessity. - Train Your Team or Use a Specialized Partner
Your billing success depends on whether your front desk, treatment coordinators, and billing team understand medical billing. If not, consider partnering with a team that already does.
How Insurance Billing Experts Supports Sleep Services
At Insurance Billing Experts, our medical billing department specializes in:
- Sleep apnea treatment and oral appliance therapy
- Medical trauma and surgical claim management
- Pediatric and complex multi-payer cases
- Navigating both commercial medical plans and Medicare requirements
We provide:
- End-to-end VOB, pre-auth, and claim submission and follow-up services
- Access to our medical clearinghouse if your practice doesn’t have one
- Ongoing guidance for coding, documentation, and compliance
- Full transparency with claim follow-ups and reporting
And we don’t require expensive program fees or bundled software to get started.
Don’t Let Billing Complicate Patient Care
When done correctly, sleep services can become a reliable and rewarding part of your practice. But without the right systems in place, they often create unnecessary stress and financial loss.
If your team needs support, clarity, or an experienced partner to handle sleep billing the right way, we’re here to help.