Statement of Medical Necessity
I am referring the above patient to Dr. Srujal Shah, DDS, DABDSM because I believe it is Medically Necessary for him/her to be fitted for a custom fitted oral appliance (E0486).
The above patient had undergone a sleep study and has been diagnosed with obstructive sleep apnea (OSA). According to the American Academy of Sleep Medicine guidelines, oral appliance therapy is a treatment option for OSA. If a CPAP intolerance a davit is attached, it is because this patient could not tolerate CPAP.
