When is D9995 used?
The D9995 dental code applies to teledentistry services provided through live, real-time audio and video communication between dental professionals and patients. This code is reported when dentists or dental hygienists perform interactive consultations, examinations, or follow-ups with patients who are not physically in the dental office. Typical applications include emergency care assessment, post-treatment check-ups, and consultations for patients facing mobility or travel difficulties. Keep in mind that D9995 functions as an add-on code—it must be billed alongside the main procedure code for the clinical service delivered during the virtual appointment.
D9995 Charting and Clinical Use
Proper documentation is crucial when using D9995. Recommended practices include:
Log the beginning and ending times of the live encounter.
Record the platform utilized (e.g., HIPAA-compliant video software).
Document the purpose of the teledentistry session and clinical observations.
List the CDT code(s) for the main dental procedure performed (e.g., assessment, consultation, or screening).
Secure and document patient authorization for teledentistry care.
Common clinical applications for D9995 include:
Assessing dental emergencies, like pain or inflammation, to decide if an office visit is required.
Post-treatment monitoring following extractions or procedures, minimizing unnecessary appointments.
Virtual consultations for patients in remote locations or those with transportation barriers.
Billing and Insurance Considerations
Effective billing of D9995 demands careful attention to insurance policies and comprehensive claim preparation. Consider these practical suggestions:
Confirm coverage for teledentistry services with each patient's insurer before scheduling. Coverage for D9995 varies among payers, with some having specific criteria.
List D9995 as an additional line item on claims, alongside the primary CDT code (such as limited oral evaluation).
Include supporting records—like session notes and patient authorization—to speed claim processing and minimize rejections.
When claims are rejected, examine the explanation of benefits for denial causes and prepare to file a claim appeal with additional documentation when needed.
Stay current with insurance policy updates, as teledentistry coverage continues to change following the pandemic.
How dental practices use D9995
Picture a patient who recently had a tooth extraction and is experiencing minor discomfort. The dental practice arranges a live video consultation to evaluate healing progress and address patient questions. During this session, the dentist remotely examines the extraction site, provides reassurance, and offers aftercare guidance. The practice bills D9995 for the teledentistry service and D0170 for the post-treatment assessment. Records include the consultation duration, platform used, patient consent, and clinical observations. This method enhances patient care, decreases unnecessary office visits, and ensures appropriate compensation for remote services.
Common Questions
Is D9995 applicable for group teledentistry sessions or limited to individual consultations?
D9995 is specifically designed for synchronous, real-time interactions between one provider and one patient. Group consultations or educational webinars do not qualify for this billing code. Each D9995 submission must represent a distinct individual patient-provider encounter with proper clinical documentation.
Which dental professionals are eligible to bill using code D9995?
D9995 may be billed by licensed dental practitioners who are authorized to deliver clinical services according to their state's practice regulations. This generally encompasses dentists and, depending on state laws, dental hygienists or dental specialists. It's essential to confirm your state's requirements and insurance carrier policies regarding provider qualification for teledentistry reimbursement.
What are the requirements for obtaining patient consent for D9995 teledentistry services?
Securing patient consent is an essential element of teledentistry services. Healthcare practices must obtain and record informed consent prior to conducting a D9995 session. The consent process should address the virtual visit format, confidentiality protocols, and potential limitations of remote dental care. Proper documentation of this consent must be maintained in the patient's medical record for regulatory compliance and audit requirements.