Incorporating orofacial myofunctional therapy (OMT) into your dental practice can be a game-changer for both patient care and practice growth. This specialized therapy addresses dysfunctions of the oral and facial muscles, playing a crucial role in treating conditions like sleep-disordered breathing, temporomandibular joint disorders (TMD), and malocclusions. But as dentists and hygienists, one key question arises: How can these treatments be financially accessible for patients while ensuring your practice is compensated fairly? The answer lies in medical billing.

What Is Orofacial Myofunctional Therapy?

OMT focuses on retraining the muscles of the mouth and face to achieve proper function, which includes breathing, chewing, swallowing, and speaking. It’s often recommended for patients with:

• Obstructive sleep apnea (OSA)
• Orofacial pain or TMD
• Orthodontic challenges due to tongue thrust or improper oral posture
• Feeding or speech difficulties

Dentists and hygienists are uniquely positioned to identify these issues during routine exams and collaborate with myofunctional therapists to provide holistic care.

Why Medical Billing for OMT Matters

Unlike traditional dental procedures, many OMT treatments qualify as medically necessary and can therefore be billed to medical insurance. This opens doors to:

1. Increased Access for Patients: Medical billing allows patients to receive necessary treatments without being limited by their dental insurance coverage.
2. Enhanced Revenue Streams: By leveraging medical insurance, your practice can offer more comprehensive services while improving cash flow.
3. Improved Patient Outcomes: With financial barriers reduced, patients are more likely to follow through with prescribed treatments, leading to better long-term health outcomes.

Key Steps for Billing OMT to Medical Insurance

1. Understand Medical Necessity: Medical insurance typically requires documentation showing the treatment’s necessity for a diagnosed condition. Common diagnoses include:
• OSA (ICD-10: G47.33)
• TMD (ICD-10: M26.60)
• Dysphagia (ICD-10: R13.10)
2. Obtain a Referral or Diagnosis: Collaboration with physicians or sleep specialists can help establish the required medical documentation. This partnership strengthens the medical necessity case.
3. Use Correct Billing Codes: Ensure you’re using the appropriate CPT® codes, such as:
• 92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder
• 97110: Therapeutic exercises to develop strength and endurance
• 97112: Neuromuscular reeducation
4. Document Thoroughly: Comprehensive notes, including treatment plans, progress reports, and patient symptoms, are critical for claims approval.
5. Verify Insurance Benefits: Always confirm the patient’s medical benefits, including coverage for OMT-related procedures.

Educating Your Team

Successful integration of OMT and medical billing requires team-wide understanding. Consider:

• Training hygienists to identify orofacial dysfunctions during routine exams.
• Educating administrative staff on medical coding and claims submission.
• Partnering with experts who can guide your team in navigating the complexities of medical billing.

Final Thoughts

By offering orofacial myofunctional therapy and utilizing medical billing, your practice can elevate the standard of care, attract new patients, and diversify revenue streams. Dentists and hygienists play a pivotal role in identifying candidates for OMT and ensuring the therapy is seamlessly integrated into treatment plans.

If you’re ready to explore how OMT and medical billing can transform your practice, consider partnering with experts who specialize in medical billing for dental practices. Together, we can unlock new opportunities for patient care and practice growth.