Negotiated reimbursement rates for D9938 across 15 states, sourced from CMS Transparency in Coverage data. 103 rate records.
D9938 refers to the adjustment of an appliance used for obstructive sleep apnea (OSA). This procedure is clinically indicated when a patient experiences discomfort or improper fit of their OSA appliance, which can affect its efficacy and the patient's quality of sleep. Proper documentation should include details of the patient's symptoms, the adjustments made, and any follow-up recommendations. Billing for this procedure may vary by payor and state, with some insurance plans covering adjustments as part of the overall treatment plan for OSA, while others may have specific limitations or require prior authorization. The average reimbursement for this code is around $101.
Reimbursement rates for D9938 vary significantly by state, payor, and provider network. The national average negotiated rate is $101. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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| State | Avg Rate |
|---|---|
| Pennsylvania | $136 |
| New York | $132 |
| Alabama | $110 |
| Louisiana | $110 |
| Massachusetts | $110 |
| State | Avg Rate |
|---|---|
| Illinois | $85 |
| Maryland | $85 |
| Indiana | $85 |
| Missouri | $84 |
| Georgia | $75 |