Teledentistry

Teledentistry is the delivery of dental care services or consultations while the member is at an originating site and the dentist is at a distant site.

PrimeWest Health allows payment for teledentistry services. Payment is allowed for interactive audio and video telecommunications that permit both real-time and “store and forward” communication between the distant site dentist or practitioner and the member. “Store and forward” is when the electronic transmission of medical information through secure transmissions lacks direct or dedicated connections and is stored in an intermediary device before being transmitted to the final destination. The services must be of sufficient audio and visual fidelity and clarity as to be functionally equivalent to a face-to-face encounter. Reimbursement for teledentistry is the same as face-to-face encounters and only a distant site can bill for services.

To be eligible for reimbursement, providers must self-attest that they meet all of the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for Telemedicine (DHS-6806). A copy of this form should be submitted to PrimeWest Health.

Eligible Recipients

Teledentistry coverage applies to PrimeWest Health members.

Originating sites

The originating site is the location of an eligible PrimeWest Health member at the time the service is being furnished via a telecommunication system. Authorized originating sites include the following:

• Health care facility
• Long-term care facility
• Public health agency or institution
• Public or private school authority
• Private non-profit or charitable organizations
• Social services agency or program
• Residential setting in the presence of licensed health care providers

An affiliate practice or originator within the Minnesota Board of Dentistry defined scope of practice must be present at originating site, which includes the following:

• Dentists
• Advanced dental therapists
• Dental therapists
• Dental hygienists
• Licensed dental assistants
• Other licensed health care professionals

List of teledentistry services

PrimeWest Health covers teledentistry claims for diagnostic services. Coverage is limited to children, pregnant woman, and limited adult benefits as specified in Minnesota Statute. 256B.0625, subd. 9 (covered services).

PrimeWest Health allows the following CDT codes for diagnostic services when performed via teledentistry:

• D0120: Periodic oral evaluation – established patient
• D0140: Limited oral exam
• D0145: Oral evaluation for a patient under three years of age
• D0150: Comprehensive oral evaluation – new or established patient
• D0170: Re-evaluation – limited, problem-focused (established patient; not post-operative visit)
• D0210: Intraoral – complete series of radiographic images
• D0220: Intraoral – periapical first radiographic image
• D0230: Intraoral – periapical each additional radiographic image
• D0240: Intraoral – occlusal radiographic image
• D0270: Bitewing – single radiographic image
• D0272: Bitewings – two radiographic images
• D0273: Bitewings – three radiographic images
• D0274: Bitewings – four radiographic images
• D0330: Panoramic radiographic image
• D1310: Nutritional counseling for control of dental disease 
• D1320: Tobacco counseling for control and prevention of oral disease
• D1330: Oral hygiene instruction
• D9310: Medical dental consultation

Documentation requirements

As a condition of payment, each occurrence of a teledentistry services must include the following documentation in the member’s file:

• The type of service provided
• The time the service began and the time the service ended
• A description of the provider’s basis for determining that teledentistry is an appropriate and effective means for delivering service to the member
• The mode of transmission of the teledentistry service
• The location of the originating and distant site

Billing teledentistry services

PrimeWest Health-enrolled dental providers who self-attest that they meet all of the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for Telemedicine (DHS-6806) can submit claims for teledentistry services using the CDT code that describes the services rendered with place of service (POS) 02.

When reporting a service with POS 02, you are certifying that you are rendering services to a member located in an eligible originating site via an interactive audio and visual telecommunications system and the following limitations apply:

• Payment for teledentistry services is limited to three per week per member
• Payment will be made for only one reading or interpretation of diagnostic tests such as X-rays, lab tests, and diagnostic assessment
• Payment is not available to providers for sending materials

Noncovered services and coverage limitations

In addition to documentation requirements, refer to the following general teledentistry guidelines:

• Out-of-state coverage policy applies to services provided via teledentistry. Consultations performed by providers who are not located in Minnesota or contiguous counties require authorization prior to the service being provided
• Payment will be made for only one reading or interpretation of diagnostic tests (e.g., X-rays) and diagnostic assessments
• Payment is not available to providers for sending materials to members, other providers, or facilities
• Payment for teledentistry services is limited to three per week per member

The following are not covered under teledentistry:

• Electronic connections that are not conducted over a secure encrypted website as specified by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security rules (e.g., Skype)
• Prescription renewals
• Scheduling appointments
• Clarification of issues from a previous visit
• Reporting diagnostic results
• Non-clinical communication

Communication via telephone, email, or fax

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Updated_03/17/2025