CurrentBlue Cross Blue Shield - WisconsinPolicy 09-900

Teledentistry

Defines when and how dental services delivered via teledentistry (synchronous or asynchronous) are reviewed and considered for coverage under the plan; applies to dentists and licensed dental personnel providing remote dental diagnostic, consultative, and limited procedures to plan members.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyTeledentistry

Policy CodePolicy 09-900

Change TypeMinor/No material changes

Effective DateJan 1, 2024

Next Review DateJan 1, 2024

Key ActionEnsure teledentistry services meet state licensure, documentation, and member contract coverage requirements before billing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

01/01/2024Policy effective date

11/01/2023Last review date

D0120–D0603Example CDT codes

Coverage Criteria for Teledentistry Services

Covered when ALL of the following are met

Teledentistry services (synchronous or asynchronous) are considered available to the same extent as in-person care provided that all listed conditions are satisfied:

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state licensure and scope: The dentist and any allied dental personnel delivering services must be licensed or credentialed and act in accordance with the laws and scope of practice of the state where the patient receives services.

Supports ADA policy citation.

lawful performance: Dental procedures performed via teledentistry must be lawfully performed within the scope of the individual licensee rendering the care.

From Dental Clinical Policy conditions.

dental necessity and standards: Procedures must be dentally necessary and appropriate as determined by the standards of generally accepted dental practice and not primarily for convenience or cosmetic purposes.

References criteria for generally accepted standards.

coverage under member contract: The procedures must otherwise be covered under the member's certificate of coverage or evidence of coverage.

Coverage depends on member contract.

privacy and documentation: Services must comply with applicable privacy and security laws and documentation/recordkeeping requirements of the state, including clinical and financial informed consent.

Documentation requirement described.

Orthodontia-specific requirements (when provided by teledentistry)

When orthodontic care is provided through teledentistry, additional program and clinical controls may be required:

monitoring protocols: Protocols for the appropriate monitoring of dental care must be established.