Provider Notice Issued 05/05/2020

Date:    May 5, 2020
 
To:       Dental Providers, Federally Qualified Health Centers (FQHCs), Encounter Rate Clinics (ERCs), Rural Health Clinics (RHCs)
 
Re:      Teledentistry Services Prompted by COVID-19
 
 
As a follow-up to the March 30, 2020 informational notice, this notice serves to inform dental providers that in response to the current COVID-19 crisis, the Illinois Department of Healthcare and Family Services (HFS) will be temporarily reimbursing dental providers for dental evaluations that occur virtually through a combination of audio and video means. This change applies to claims billed for participants covered under fee-for-service as well as a HealthChoice Illinois managed care plan.
 
These changes are effective for dates of service from March 9, 2020 until the public health emergency no longer exists.
 
Dental providers must continue to be in compliance with all federal and state laws, regulations and guidance regarding telemedicine, including a practitioner's obligations under the Health Insurance Portability and Accountability Act (HIPAA).
 
To be eligible for reimbursement of teledentistry services:
·         A communication system where information exchanged between the dental provider and the patient during the course of the synchronous telehealth service is of an amount and nature that would be sufficient to meet the key components and requirements of the same service when rendered via face-to-face interaction.
  • The dental provider must be an enrolled provider through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) enrollment for HFS.
  • The dental provider does not need to have a current relationship with the patient in order to perform teledentistry.
  • Claims for teledentistry should be billed with the Current Dental Terminology (CDT) codes of D9995 or D9996 for the telehealth service, in accordance with the code definitions, in conjunction with CDT Code D0140 – Limited Oral Evaluation.
  • Place of Service must be listed as “02” when submitting claims.
 
The following codes may be used by dental providers providing teledentistry in accordance with the American Dental Association (ADA) and HFS program guidelines:

CDT Code
Description
Benefit Limitation
Rate
D9995
Teledentistry – synchronous; real-time encounter
Documentation shall be maintained in the patient chart. This code shall be reported in addition to other diagnostic procedure (D0140) on the same date of service.
 
$13.19
D9996
Teledentistry – asynchronous; information stored and forwarded to a dentist for subsequent review
Documentation shall be maintained in the patient chart. This code shall be reported in addition to other diagnostic procedure (D0140) on the same date of service.
$9.24
D0140
Limited oral evaluation – problem focused
Benefit limitation – relaxed.
Documentation shall be maintained in the patient chart
 
$16.20
 
If an in-person visit becomes necessary as a result of a teledentistry evaluation, dental providers will need to plan for efficient in-person emergency visits should those be necessary to minimize the appointment time. The goal is to have all information, explanations, consents, etc. exchanged or completed prior to the patient arriving at the dental office.
 
Encounter Clinics
As with any other dental providers, encounter clinics should determine if a patient needs emergency dental services before seeing them in the clinic.
 
Payment made by HFS for allowable encounter services will be made at the all-inclusive rate established by HFS for each encounter. HFS will allow billing an encounter rate with new or existing patients as long as the encounter is of a nature that would be sufficient to meet the key components of a face-to-face encounter. A face-to-face dental encounter is defined as face-to-face visit with a dentist or dental hygienist.
 
The encounter clinic must add D0999 to the first line of the claim with Place of Service of 02.
 
 
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service issues, your DentaQuest provider representative or to the applicable MMAI or HealthChoice Illinois managed care plan.
 
 
 
Kelly Cunningham
Interim Medicaid Administrator
 

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