On Friday, March 20, 2020, Delta Dental of Massachusetts announced an interim policy allowing for teledentistry or virtual exams. Effective March 20, and for a period of 30 days, offices that have the capability to perform evaluations via audio or video technology should submit the claim using the Oral Evaluation – Problem-Focused code (D0140) when performing virtual evaluations for Delta Dental of Massachusetts accounts. The claim will be paid if the patient has Delta Dental of Massachusetts insurance and has coverage/benefits available.
Blue Cross Blue Shield of Massachusetts announced that effective March 23, 2020, and until further notice, it will cover consultations by telephone or video (“virtual consultations”) between dental providers and their patients, for all members who already have coverage for problem-focused exams (D0140), with no cost share (deductible, copayment, or co-insurance). Per Blue Cross, dental offices can report virtual consultation services using CDT code D0140 (Limited Oral Evaluation – Problem Focused). Virtual consultations should be patient-initiated and related to a specific dental problem that would otherwise have required an in-person office visit. Blue Cross is instructing providers to document in the patient’s chart the problem that necessitated the telephone or video consultation and what you recommended to the patient.
The MassHealth Dental Program approved the ability for dental services to be provided via telehealth for both MassHealth and HSN beginning March 12, 2020. The billing system has been updated to accept claims when billed with place of service telehealth, and the MassHealth Provider Web Portal has been updated to provide place of service option telehealth. If the option to bill telehealth is not available to submit EDI claims, please submit all telehealth claims utilizing the provider web portal choosing place of service option. Per the MassHealth All Provider Bulletin 289, the test for whether you can bill something to MassHealth via place of service telehealth (which includes both live video and telephone) is:
- Were you able to bill it to MassHealth and be paid before?
- Is it clinically appropriate to be delivered via telehealth?
- Is it medically necessary for the member?
- Are you conforming with the guidance in Appendix A of the Provider Bulletin 289?
If the answer to these questions is “yes,” then the visit can be billed and paid by MassHealth at the rate previously paid using the codes that are appropriate for the service(s) provided. Please note that MassHealth is not adopting specific telehealth codes, changing frequencies/limitations, or waiving eligibility or provider credentialing requirements.
If you need further clarification on filing a teledentistry claim with one of the insurers listed above, please contact them directly. If your practice accepts dental insurance from a carrier not listed above, you should reach out to them to ask if they are covering teledentistry or virtual exams.