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    v1.0.30
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyLouisiana Medicaid Teledentistry Coverage | OpenPa…
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    CurrentLouisiana Department of HealthPolicy 20-11

    Teledentistry During the COVID-19 Declared Emergency

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    Temporary Louisiana Medicaid reimbursement and billing requirements for teledentistry used to triage, evaluate, and support emergency dental services during the COVID-19 declared emergency.

    Policy Summary
    PayerLouisiana Department of Health
    PolicyTeledentistry During the COVID-19 Declared Emergency
    Policy CodePolicy 20-11
    Change TypeTemporary reimbursement and billing requirements
    Effective DateMarch 23, 2020
    Next Review DateN/A
    Key ActionFor non-FQHC/RHC claims, report D9995 in addition to D0140 and use place of service/place of treatment code 02.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2 CDT codesAllowable teledentistry-related codes
    POS 02Required place of service code
    In-person rateNon-FQHC/RHC reimbursement
    None formalSite limitations

    Teledentistry Reimbursement Criteria

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Teledentistry Reimbursement Criteria

    For dates of service on or after March 23, 2020, dentists may be reimbursed for appropriate use of teledentistry to render emergency dental services during the COVID-19 declared emergency. Reimbursement is at the same level as for in-person services. All applicable clinical, technology, billing, and documentation requirements below must be met.

    ALL of the following

    • The service is an appropriate emergency dental service rendered during the COVID-19 declared emergency.

      Teledentistry is not permitted for outgoing or ‘check-in’ calls with beneficiaries.

    • The service is delivered through an interactive audio/video telecommunications system.

      A secure, HIPAA-compliant platform is preferred when available. For the duration of the COVID-19 emergency, if such a system is not immediately available when needed, providers may use everyday communications technologies, including cellular phones with widely available audio/video communication software. The HHS Office for Civil Rights maintains a list of software deemed appropriate for this event at https://www.hhs.gov/hipaa/for-professionals/special-topics/emergencypreparedness/notification-enforcement-discretion-telehealth/index.html.

    • ONE applicable billing pathway

      • Non-FQHC/RHC billing

        • Report D9995 in addition to D0140.
        • Bill the claim using place of service (POS)/place of treatment code 02.

          The claim will be denied if POS/place of treatment code 02 is not used.

        • If the teledentistry oral examination results in an in-person visit during the current COVID-19 declared emergency, code and bill the office services according to the current policy.

      • FQHC/RHC billing

        • Bill all dental services using encounter code D0999.
        • On subsequent lines, list the specific dental service provided using D0140 and the teledentistry code D9995.
        • Include zero or usual/customary charges for each service provided.
        • Bill the claim using place of service (POS)/place of treatment code 02.

          The dental claim will be denied if POS/place of treatment code 02 is not used.

        • Reimbursement is at the all-inclusive prospective payment rate on file for the date of service.

          Follow-up procedures cannot be billed separately.

    • Maintain the usual medical documentation needed to support reimbursement of the visit.
    • Adhere to all teledentistry-related requirements of the applicable professional licensing boards.
    • For questions regarding this message or fee-for-service claims, contact DXC Provider Relations at (800) 473-2783 or (225) 924-5040. Direct questions regarding Dental Benefit Plan Manager claims to MCNA Dental Provider Relations at 1-855-701-6262.

    Covered Codes and Claim Requirements

    Emergency problem-focused oral evaluationmixedCovered
    D0140Limited oral evaluation, problem focused; may address a specific oral health problem, dental emergency, trauma, or acute infection.
    Synchronous teledentistry encountermixedCovered
    D9995Teledentistry, synchronous; real-time encounter.
    FQHC/RHC dental encounter codemixedCovered
    D0999Dental encounter code required for FQHC/RHC billing, with specific services listed on subsequent claim lines.
    Required place of servicemixedCovered
    02Place of service/place of treatment code required for teledentistry claim submissions.

    Provider Billing and Service Requirements

    Note

    Limit teledentistry to emergency dental care

    Use teledentistry only when appropriate for rendering emergency dental services, including triage or evaluation to determine whether a situation is urgent or emergent.

    Denial Risk

    Avoid prohibited calls and check-ins

    Do not use teledentistry for nonclinical communications. These uses are not permitted under the policy.

    • Do not use teledentistry for outgoing calls.
    • Do not use teledentistry for beneficiary “check-in calls.”
    Billing Rule

    Submit the required non-FQHC/RHC billing combination

    For non-FQHC/RHC claims, report D9995 in addition to D0140 and submit the claim using place of service/place of treatment code 02. Failure to use code 02 will result in denial.

    • D0140: limited oral evaluation, problem focused.
    • D9995: teledentistry, synchronous; real-time encounter.
    • Use POS/place of treatment code 02.
    Billing Rule

    Follow FQHC/RHC encounter billing rules

    For FQHC/RHC claims, bill all dental services using encounter code D0999. List D0140 and D9995 on subsequent claim lines, include zero or usual/customary charges for each service, and use POS/place of treatment code 02; otherwise, the dental claim will be denied.

    • Use D0999 as the encounter code.
    • Enter D0140 and D9995 on subsequent lines.
    • Include zero or usual/customary charges for each service provided.
    • Use POS/place of treatment code 02.
    Billing Rule

    Apply FQHC/RHC payment limitations

    FQHC/RHC reimbursement is paid at the all-inclusive prospective payment rate on file for the date of service. Follow-up procedures cannot be billed separately.

    • Apply the all-inclusive prospective payment rate for the date of service.
    • Do not bill follow-up procedures separately.
    Documentation Required

    Use permissible telecommunications technology

    Deliver eligible teledentistry services through an interactive audio/video telecommunications system. A secure, HIPAA-compliant platform is preferred; during the COVID-19 emergency, everyday communications technologies such as cellular phones with widely available audio/video software may be used if a HIPAA-compliant system is not immediately available.

    • Use interactive audio/video technology.
    • Prefer a secure, HIPAA-compliant platform when available.
    • Use permitted commonly available audio/video technology only when a compliant system is not immediately available during the emergency.
    Note

    Apply flexible originating and distant site rules

    The patient may be at home or another originating site, because there is no formal limitation on the originating site. The provider’s preferred distant site is a healthcare facility, but another location may be used when facility disruption or provider safety concerns exist, provided the same standard of care can be met.

    • The originating site may include the patient’s home.
    • A distant site healthcare facility is preferred.
    • If the provider practices elsewhere, maintain the same standard of care.
    Documentation Required

    Maintain documentation and licensure compliance

    Maintain the usual medical documentation needed to support reimbursement of the visit and adhere to all teledentistry-related requirements of the applicable professional licensing board.

    • Maintain usual medical documentation supporting reimbursement.
    • Follow applicable professional licensing-board requirements for teledentistry.

    Teledentistry Site and Encounter Terms

    Originating site
    DefinitionThe originating site is where the patient is located.
    Permitted locationsThere is no formal limitation on the originating site; it may include, but is not limited to, the patient’s home.
    Distant site
    DefinitionThe distant site is where the provider is located.
    Preferred locationThe preferred location for the distant-site provider is a healthcare facility.
    Alternative locationIf a healthcare facility is disrupted or the provider’s personal health and safety is at risk, there is no formal limitation on where the provider may be located, as long as the same standard of care can be met.
    Synchronous teledentistry
    DefinitionSynchronous teledentistry is a real-time encounter using synchronous telecommunications technology.
    Policy Summary
    PayerLouisiana Department of Health
    PolicyTeledentistry During the COVID-19 Declared Emergency
    Policy CodePolicy 20-11
    Change TypeTemporary reimbursement and billing requirements
    Effective DateMarch 23, 2020
    Next Review DateN/A
    Key ActionFor non-FQHC/RHC claims, report D9995 in addition to D0140 and use place of service/place of treatment code 02.
    SourceLink
    On This Page
    Teledentistry Reimbursement CriteriaCovered Codes and Claim RequirementsProvider Billing and Service RequirementsTeledentistry Site and Encounter Terms