Teledentistry or In-Person Dental Visits: Where Do Insurance Reimbursements Apply?

09.19.2021
| 10 min read

Don’t mess with insurance reimbursements! That might be the thought when considering comparisons between (standard) in-person dental appointments and teledentistry appointments.

The hesitation is real for you (the provider) and your patients. For good reason since sweeping changes to coverage allowances have reduced payouts.

Still, there’s plenty of equally good reasons to stay the course as teledentistry technology use increases. Pandemic relevance aside - patients are showing preference for teledentistry’s convenience and providers are innovating around its boost to the patient experience.

The lingering question about insurance coverage

The earlier stated concern has to do with insurance reimbursement rates.

Is there a substantial difference in reimbursements for in-person dental visits vs. teledentistry visits?

A recent article in Dr. Bicuspid addressed this concern. They cited “analysis of thousands of oral and maxillofacial surgery claims” in the Journal of Oral and Maxillofacial Surgery.

”’Our results suggest that providers can deliver care through telemedicine or in-person visits and still receive similar reimbursement from insurance companies, for both new and established patients,’ wrote the study authors, led by Srighana Nadella, a Doctor of Dental Medicine candidate at the University of Pennsylvania School of Dental Medicine.[1]

VirtualDentalClaimReimbursement

Specifics included the following highlights:

  • A comparison of “more than one year of claims data from telemedicine and in-person office visits at University of Pennsylvania Health System Oral and Maxillofacial Surgery Service.”
  • Claims represented “the same 13 providers and were limited to Current Procedural Terminology (CPT) codes utilized for both telemedicine and in-person visits.”
  • 6,082 claims from 4,045 patients were represented in the analysis total and more than 700 patients had both claims types.
  • Average reimbursement rate for in-person visits “netted” $109.50 per visit compared with $98.07 per telemedicine visit (a non-substantial difference was noted). [2]

PatientPrefernceTeledentistry

Analysis concluded the following “significant finding”:

One significant finding in the study, however, was the difference in types of patients who opted for each service. When comparing claims for new and established patients, a greater proportion of established patients attended teledentistry appointments (85%) than in-person appointments (63%).[3]

The study’s authors “cautioned” that “their study was limited to a single academic institution and did not include reimbursement for facility fees. And the added caveat included a reminder that “reimbursement policies vary widely between states and by payor.” [4]

A coverage “green-light?”

Insurance providers are recognizing the value in teledentistry (as it’s hoped you do as well). In some instances the coverage and reimbursement questions might receive a “maybe.”

But for the most part you should consider the service “green-lighted” - with a few qualifications.

1-Your location

Laws and dental board guidelines differ state to state. For example, Texas recently passed a bill that approved teledentistry services having been a hold-out for a period of time.

Note that 29 states have requirements in place for private insurance to cover teledentistry as they would in-person dental visits. You should keep in mind that though a particular state doesn’t recognize insurance coverage for teledentistry there are other options that could make a determination in favor of it.

Research and consulting with your state’s dental board is recommended.

2-Your provider network

As you know coverage policies differ from company to company. A particular provider or state might require you to confirm coverage details before you schedule a particular patients virtual visit.

Again, the majority of carriers are recognizing the growing teledentistry trends and are increasing their allowances. They recognize too that they will benefit as providers are innovating around teledentistry and patients are welcoming it.

3-Your relationship to Medicare and Medicaid

Dental care is limited under Medicare as you’re perhaps aware. The same would likewise apply to teledentistry under the dental umbrella.

Certain requirements apply to Medicare coverage for a teledentistry visit. For example, there must be “two-way” video connection or another allowable need for the service.

Do your research before proceeding under a Medicare policy. And if applicable, reference your patient’s supplemental Medicare coverage to determine if any additional policy benefits apply to teledentistry services.

About Medicaid….

Some opportunities exist for Medicaid to cover a teledentistry visit. As you would expect, state laws apply across the board with leniency within some specific state’s recognition of the service. California has specific laws that provide for teledentistry for those who have Medicaid benefits.

Also, you would likely be required as a dental provider to participate in Medicaid. On a national scope, around 40% of dentists do so. [5]

4-Your coding accuracy

Two CDT codes apply to teledentistry services.

  • 1-Synchronous teledentistry services: real-time video/virtual consultations with mutual interaction.
  • 2-Asynchronous teledentistry services: shared or stored information from a patient or referral source (e.g. reviewing data or digital images, etc).

It’s essential to clarify the specific visit as you file with the patient’s insurance. Was it synchronous (real-time) or asynchronous (shared/stored information)?

And you’ll want to attach your teledentistry code to the patient’s oral evaluation or case management code.

The following codes apply to teledentistry visits:

  • D9995 - Teledentistry (Synchronous)
  • D9996 - Teledentistry (Asynchronous)

Remember to consult the required codes for the above mentioned Oral Evaluation and Case Management.

The green-light is on but it’s vital that you stay current with what’s evolving around teledentistry in your state, with your provider network, and other beneficial service related opportunities.

Check out the following on-topic resources:

How Teledentistry Can Improve Payer Network Relationships with Providers and Patients

How do I bill for Teledentistry using CDT Codes D9995 and D9996?

It’s time to commit to teledentistry…on a secure, dedicated fully-equipped platform

Teledentix is an innovative, turn-key teledentistry solution created by Virtual Dental Care. The all-in-one platform will enable you to adapt teledentistry to your patient care and extend your services beyond the walls of your dental practice…and improve your patient care in the process.

  • Teledentix provides an easy-to-use video conferencing tool that’s secure, HIPAA compliant, and specific to dentistry.
  • Teledentix Basic is a perfect starting point. Begin with a free trial and then transition to a very low monthly fee. You and your patients can join unlimited video conferences including screen-share, file-share, video-share, and real-time chat communications.

LEARN MORE about the Teledentix platform.

 

[1]                https://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&itemId=329111

[2]                https://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&itemId=329111

[3]                https://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&itemId=329111

[4]                https://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&itemId=329111

[5]                https://www.dentistry.com/articles/will-insurance-cover-teledentistry

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