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    v1.0.30
    OpenPayerPolicy UpdatesDental/Oral & MaxillofacialWellpoint Teledentistry Policy Update | OpenPayer
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    ModifiedWellpointPolicy 09-900

    Teledentistry

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    Coverage and delivery requirements for dental diagnostic, consultative, educational, preventive, imaging, and limited dental services provided through synchronous or asynchronous teledentistry.

    Policy Summary
    PayerWellpoint
    PolicyTeledentistry
    Policy CodePolicy 09-900
    Change TypeModified — no material clinical or coverage changes
    Effective DateJan 1, 2025
    Last ReviewNov 5, 2024
    Next Review DateN/A
    Key ActionDocument teledentistry services according to applicable state recordkeeping and informed-consent requirements.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Synchronous or asynchronousTeledentistry modalities addressed
    Same as in-personCoverage standard
    Patient-state licensedProvider licensure requirement
    10Clinical oral evaluation codes
    10Diagnostic imaging codes

    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.

    10Preventive codes

    Covered Teledentistry Services

    Covered teledentistry services

    Teledentistry benefits are available to the same extent as services provided in person when all applicable conditions are met.

    • The dental procedure can be lawfully performed within the scope of the individual licensee who renders the care.
    • The procedure is dentally necessary and appropriate as determined by generally accepted dental practice.
    • The procedure is otherwise covered under the member's certificate of coverage or evidence of coverage.
    • The dentist or allied dental personnel delivering diagnostic procedures or oral health services is licensed in the state where the patient receives services, or is otherwise authorized by that state's dental board, and conforms to applicable dental practice laws in the patient's state and the state where the dentist is licensed.
    • Services are delivered by licensed dentists or licensed dental personnel in accordance with applicable privacy and security laws for private health information and applicable state requirements for recordkeeping and clinical and financial informed consent.

    Quality, safety, and orthodontic requirements

    Teledentistry services must satisfy the following quality and safety requirements.

    • The dentist retains responsibility and authority for the safety and quality of services provided through teledentistry.
    • Services follow evidence-based practice guidelines to the degree such guidelines are available.
    • For orthodontia, the orthodontic entity may be required to maintain appropriate monitoring, direct and general supervision, credentialing, initial and ongoing evaluation, case-selection, and referral protocols.

    Applicable Dental Codes

    Clinical Oral EvaluationsCPT
    D0120periodic oral evaluation
    D0140limited oral evaluation
    D0145oral evaluation for a patient under three years of age
    D0150comprehensive oral evaluation
    D0171re-evaluation post-operative
    D0180comprehensive periodontal evaluation
    D0190screening of a patient
    D0191assessment of a patient
    D0601caries risk assessment - low
    D0602caries risk assessment - medium
    1–10 of 11
    1/2
    Diagnostic ImagingCPT
    D0210intraoral - comprehensive series
    D0220intraoral - periapical first image
    D0230intraoral - periapical each additional image
    D0240intraoral - occlusal image
    D0270bitewing - single image
    D0272bitewings - two images
    D0273bitewings - three images
    D0274bitewings - four images
    D0277vertical bitewings - 7 to 8 images
    D0330panoramic image
    PreventiveCPT
    D1110prophylaxis - adult
    D1120prophylaxis - child
    D1206topical application fluoride varnish
    D1208topical application of fluoride excluding varnish
    D1301nutritional counseling
    D1320tobacco counseling
    D1330oral hygiene instruction
    D1351sealant
    D1352sealant repair
    D1354interim caries arresting medication application
    ICD-10 CM Diagnoses for Dental Diseases and ConditionsICD-10
    No codes listed

    Provider Requirements and Denial Conditions

    Documentation Required

    Records and Informed Consent

    Document all dental services delivered through teledentistry in accordance with applicable state recordkeeping requirements. Obtain and retain clinical and financial informed consent as required by applicable law.

    • Maintain documentation of the teledentistry service and the clinical care provided.
    • Follow all applicable state requirements for recordkeeping and clinical informed consent.
    • Follow all applicable state requirements for financial informed consent.
    Note

    Communication and Referral Protocols

    Maintain the capability to contact both the allied dental personnel providing the service and the patient. Establish and follow protocols for appropriate medical, general dentistry, and dental specialty referrals whenever necessary.

    • Maintain communication capability with the patient and participating allied dental personnel.
    • Use established medical referral protocols when medically indicated.

    Policy Background

    Teledentistry delivers diagnostic, consultative, educational, and limited dental services to patients at a different location through information and audio-visual communication technology. Services may be provided synchronously or asynchronously and are evaluated under the same general coverage standard as comparable in-person services, subject to applicable licensure, scope-of-practice, dental-necessity, privacy, documentation, and member benefit requirements.

    Key Definitions

    Teledentistry
    DefinitionThe delivery of dental services, including diagnostic, consultative, and educational limited dental procedures, by a dentist to a patient located at a different location through information and audio-visual communication technology.
    Policy Summary
    PayerWellpoint
    PolicyTeledentistry
    Policy CodePolicy 09-900
    Change TypeModified — no material clinical or coverage changes
    Effective DateJan 1, 2025
    Last ReviewNov 5, 2024
    Next Review DateN/A
    Key ActionDocument teledentistry services according to applicable state recordkeeping and informed-consent requirements.
    SourceLink
    On This Page
    Covered Teledentistry ServicesApplicable Dental CodesProvider Requirements and Denial ConditionsPolicy BackgroundKey Definitions
  1. Use established general dentistry and dental specialty referral protocols when indicated.
  2. Include protocols for handling patient referral in orthodontic teledentistry services.

    3. Unsupported block type: documentation

    Unsupported block type: denial_risk

    Denial Risk

    Failure to Meet Delivery and Clinical Protocols

    The dentist retains authority and responsibility for the safety and quality of teledentistry services. Failure to satisfy applicable licensure, authorization, privacy, security, delivery, supervision, documentation, referral, or clinical requirements may create denial or review risk.

    • Use only licensed or otherwise state-authorized dentists and dental personnel, and comply with the dental practice acts in the state where the patient receives services and where the dentist is licensed.
    • Protect patient private health information and comply with applicable privacy and security laws and regulations.
    • Follow evidence-based practice guidelines when available to support patient safety, quality of care, and positive health outcomes.
    • Satisfy applicable direct and general supervision, credentialing, monitoring, evaluation, case-selection, and referral protocols.
    • Reimbursement is based on procedures performed, not on teledentistry codes themselves; verify member-specific coverage before billing.
    • Failure to meet applicable requirements may result in claim denial, post-service review, or other reimbursement consequences.