Oral Appliances to Remain Under DME Benefit for 2026

On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (MPFS) proposed rule. This rule includes proposals related to payment for professional services furnished by physicians and other clinicians under the Medicare program.

The American Academy of Dental Sleep Medicine (AADSM) has been tracking this rule closely to monitor whether CMS would propose transitioning coverage and payment of oral appliances for obstructive sleep apnea (OSA) from the Medicare Durable Medical Equipment (DME) benefit to the MPFS. As a reminder, in the CY 2025 MPFS proposed rule issued in July 2024, CMS suggested that it was considering such a change. Specifically, CMS questioned whether oral appliances for OSA qualified as DME and sought information regarding the provision of oral appliance therapy that could inform a future proposal for covering services related to oral sleep apnea appliances under the MPFS. 

In response, the AADSM has been engaged in ongoing advocacy to prevent coverage and payment for oral appliance therapy from shifting to the MPFS, including by submitting formal comments to CMS in response to the CY 2025 MPFS proposed rule, meeting with CMS leadership and staff, submitting letters to the Secretary of the Department of Health and Human Services (HHS) and the CMS Administrator, submitting testimony to the House and Senate Appropriations Committees, and requesting report language in the upcoming fiscal year 2026 funding bill for HHS. Our messages have focused on concerns around increased risk of patient harm and significant provider disruption. We have also underscored that oral appliances are appropriately classified as custom-fabricated DME. 

Given these efforts, the AADSM was pleased to see that CMS did not include any proposals in the CY 2026 MPFS proposed rule to transition coverage and payment of oral appliances to the MPFS. As a result, oral appliances will remain under the Medicare DME benefit for CY 2026. 

The AADSM will remain vigilant in monitoring and responding to future Medicare proposals that would threaten members’ ability to effectively furnish oral appliances for OSA to Medicare beneficiaries.