Delta Dental of South Dakota now reimburses certain services when provided via teledentistry, as does the South Dakota Medicaid program.
Teledentistry can be an effective way to create efficiency in care delivery, increase access to care, and improve the quality of care. Information and resources are provided below to help maximize benefits to both the patient and the care team when using technology to deliver care.
Effective January 1, 2022, Delta Dental of South Dakota reimburses certain services when provided via teledentistry. Services provided via teledentistry must meet the applicable standard of care and be provided through a secure audio/visual service. When reporting a service completed via teledentistry, providers are certifying the services rendered to the patient were functionally equivalent to in-person services.
The following services may be provided via teledentistry:
Coverage of services done using teledentistry is subject to the Delta Dental national processing policies, including any frequency limitations. Delta Dental will make benefit determinations based on applicable policies and member plan documents.
Providers that primarily or only see Delta Dental of South Dakota members via teledentistry will only be reimbursed for D0140 (i.e., a dentist who works for an online teledentistry service based in another state can only receive payment for a problem-focused exam, not a comprehensive or periodic exam).
The services must be of sufficient audio and visual fidelity and clarity to be functionally equivalent to a face-to-face encounter. Services provided via email, audio-only telephone, and facsimile transmissions as teledentistry services are not reimbursable.
When reporting a service completed via teledentistry, providers are certifying the services rendered to the patient were functionally equivalent to a face-to-face encounter.
Providers must include one of the following codes on claims for services completed via teledentistry:
The teledentistry code should be submitted at the provider’s usual and customary rate.
Download a [.pdf] copy of the teledentistry coverage guidance. The document includes a list of covered service codes and billing, reimbursement, and documentation information. (updated 2/10/22)
Medicaid also covers teledentistry. See eligibility information, covered services and limits, documentation requirements, and claim instructions in this [.pdf] of the SD Medicaid teledentistry services manual.
Reimbursement for teledentistry is equal to reimbursement for face-to-face encounters. CDT D9995 or D9996 are reported in addition to other procedures delivered on the date of service but are not separately reimbursable. Teledentistry is considered part of the service completed and inclusive of overall patient management.
Delta Dental of South Dakota will treat claims for services completed by teledentistry the same as a face-to-face encounter of the same code. Providers must document services completed via teledentistry in the same manner as in-person services. This includes documentation of details about the date and time, mode of service delivery, service provided, diagnoses, treatment plan, etc. in the patient’s clinical notes.
Coverage guidance updated 2/10/2022
In a special online presentation for dental providers in South Dakota, Dr. Nathan Suter explored the digital transformation of patient care, and explained the use and benefits of teledentistry and utilization of digital technologies. "Teledentistry and the Digitization of Patient Care" was recorded on September 23, 2021. Click the image below to play the video or watch it on YouTube.