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New teledentistry reimbursement available to Medi-Cal Dental providers during COVID-19 crisis

April 23, 2020 5378

Medi-Cal Dental providers can now submit claims and be reimbursed for patient consultations by telephone or livestreaming video, DHCS announced in a special edition of its April Provider Bulletin. CDA advocated for DHCS to implement the policy to assist California dentists.

Medi-Cal Dental providers can now submit claims and be reimbursed for patient consultations by telephone or livestreaming video, the Department of Health Care Services announced in a special edition of its April 2020 Provider Bulletin, “Temporary Medi-Cal Dental Teledentistry Flexibilities.”

CDA advocated for DHCS to implement the policy to assist California dentists who currently are not providing routine in-person care due to the state directive and CDC recommendation during the COVID-19 pandemic but who are still providing urgent or emergency consultations to their patients using telehealth technology.

Medi-Cal Dental providers can use the CDT code D9430 for digital consultations with their patients and will receive the Schedule of Maximum Allowances rate of $20 plus an additional supplemental $12 payment through Proposition 56 revenues. Providers should bill in conjunction with the teledentistry code D9999 (code D9995 after May 16), which documents that the consult was a synchronous (real-time) encounter.  

The temporary teledentistry exception is backdated to March 25 and is in effect until further notice.

  • Use CDT code D9430
  • Use the code only for livestreaming video or telephone consultation with a Medi-Cal patient with oral health issues in place of an in-person visit.
  • Provide appropriate documentation of the consultation on the claim document in the comments section.

Telehealth is the mode of delivering health care services and public health through information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.

Find more telehealth resources for dentists, including a guide to getting started with telehealth, in CDA’s dedicated COVID-19 information center. Or, see the ADA's resource: D9995 and D9996 – ADA Guide to Understanding and Documenting Teledentistry Events.