Teledentistry and Insurance Coverage/Coding?

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September 21, 2021

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Teledentistry and Insurance Coverage/Coding?

“Does my insurance cover it?” Understandably, this is the first question every patient asks regarding teledentistry. The answer heavily depends on several factors, which we’ll break down in this article. 

Although teledentistry has been around for over 2 decades, it recently gained spotlight attention during the COVID pandemic. Dentists and patients alike were desperately seeking safer, alternative ways to have consultations, emergency triage, and post-op visits remotely.

Teledentistry was initially designed to “improve patient care, increase dental education, and promote communication between dentists and labs.”1 From the initial establishment until the present time, a myriad of benefits have come from teledentistry, including convenience, safety of care, lower costs for patients, ability to serve those in hard-to-reach remote areas, and a decrease in dental-related emergency visits. 

Services that patients are able to receive from teledentistry have also expanded to include the following:

  • Triage Emergency Visits
  • Pre-exam and Post-op visits
  • 2-Way Audiovisual Communication
  • Discussion of Diagnosis and Treatment Plans
  • Live Group Interactions with Staff & Specialists
  • Transfer of Educational Resources and Information
  • Asynchronous Transmission of Health Records Including Images 

The list of uses for teledentistry continues to grow as the number of patients and dentists utilizing it drastically increases. One thing that’s for sure, is that teledentistry is here to stay long-term.

Does Insurance Cover It?

The exploding demand for teledentistry has led patients and dentists flocking to insurance companies seeking information about coverage status for telehealth services. Primary factors affecting insurance coverage include: location, insurance provider, and policy.

Location & Insurance

Because the scope of teledentistry and telehealth services varies, state dental boards, policy makers, and insurance providers differ in which services are permitted or covered, along with a host of particular regulations. Dentists have also witnessed changes in those legislations over the course of the COVID pandemic. 

Some states have established extensive teledentistry laws, whereas with others, they are nonexistent. On top of that, private payers vs state medicaid programs also reimburse differently depending on the state. The discussion on reimbursement for telehealth can get quite complex quickly.

Lawmakers go to a great extent in defining elements of reimbursement including, but not limited to matters like payment parity laws. This law requires insurers to pay for telehealth at the same rate as in-person services, and exists in some states, but not others. As you can imagine, lawmakers and insurers have presented arguments from both sides, for and against payment parity laws such as:

  • The amount of effort expended towards telehealth vs in-person services
  • The value of care provided via telehealth vs in-person care
  • Expenses from the practitioner's end in telehealth vs in-person visits
  • The potential for telehealth overuse
  • And so forth…

In-depth articles have been written solely about telehealth payment parity, in addition to numerous other factors taken into consideration when determining insurance reimbursement for telehealth services.

How Should You Code for Teledentistry?

Knowing proper coding for teledentistry will save endless headaches of reimbursement delays and denials. The first step is ensuring that the actual provider of the service(s) is submitting the CDT codes. Secondly, include the relevant codes for services provided in addition to the full teledentistry CDT code.

The two full CDT codes are:
  • D9995 teledentistry: synchronous; real-time encounter. 
  • D9996 teledentistry: asynchronous; information stored and forwarded to the dentist for subsequent review. 

(The two full CDT codes should be reported in addition to other procedural codes (e.g. diagnostic) delivered to the patient on the date of service.)

  • D0140 – limited oral evaluation – problem focused 
  • D0170 – re-evaluation – limited, problem focused (established patient) 
  • D0171 – re-evaluation post – operative office visit

Example: D0140 on line item 1, D9995 on line item 2

Here’s a free resource to better help you understand teledentistry coding.

Where do Dental Insurance Providers Stand on Telehealth Coverage?

Medicare* - Current Federal laws and policies
Live Video: Yes
Store-and-Forward: yes
Remote Patient monitoring: Yes, with with limitations3
Details can be found here.

Aetna*
Live Video and Store-and-Forward Telemedicine with limitations4
Further details can be found here.

Blue Cross Blue Shield*
Details about teledentistry services can be found here.

Delta Dental*
Teledentistry services are dependent upon plans5
Further details can be found here.

United Healthcare Dental*
Details about services eligible for teledentistry can be found here.

Humana Dental*
Details about teledentistry services can be found here.

*Note that teledentistry/telehealth coverage policies are continuously changing. Current coverage status must be verified with the Insurance Provider.

To learn about teledentistry regulations in your state click here

Moving Forward

The future of state regulations and insurance coverage for teledentistry, will continue to be a hot topic across the board. More research and understanding of the benefits vs drawbacks of teledentistry are still in progress and require thorough evaluation before sound policies are established. Learn how mConsent can set your practice up with convenient teledentistry services.

References:

1 https://virtudent.com/2019/12/10/what-is-teledentistry-anyway/
2 https://www.ada.org/~/media/ADA/Publications/Files/CDT_D9995D9996-GuideTo_v1_2017Jul17.pdf
3 https://www.cchpca.org/federal/
4 https://www.aetna.com/health-care-professionals/covid-faq/telemedicine.html
5 https://www.deltadentalri.com/Content/Docs/Delta_TeledentistryBenefit_2020.pdf

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