Ohio Medicaid now covers D0140 through telehealth

This week the Ohio Department of Medicaid announced new COVID-19 emergency telehealth rules impacting dentistry. 

 

Beginning on April 15, 2020, dentists will be able to bill the Ohio Medicaid fee-for-service and managed care programs (i.e., the Medicaid HMOs) and MyCare Ohio Plans for the D0140 (limited oral evaluation – problem focused) procedure code when provided via telehealth. Claims for dates of service beginning March 9, 2020 and for the duration of the state of emergency will be considered valid under the new guidelines.  

 

The D0140 code will be covered as an exam involving more than a triage or screening service when provided through teledentistry. It is important to note that the D9995 (teledentistry – synchronous, real-time encounter) procedure code must be billed in conjunction with D0140 to indicate the exam was provided through teledentistry. When billing for the procedure on a professional claim (i.e. FQHCs), providers should use the GT modifier and include procedure code D9995 to indicate the service was provided through telehealth. The place of service code should reflect the practitioner’s physical location.

 

It should also be noted that the D0170 (re-evaluation, limit) and D0171 (re-evaluation – post-operative office visit) procedure codes are not separately reimbursed by ODM when provided in a face-to-face visit. They will not be separately reimbursed when provided through telehealth. While routine assessment, post-operatively or of a previously existing condition, is not separately reimbursed, evaluation of a specific problem or dental emergency is reimbursable under D0140 through teledentistry. 

 

Similarly, Ohio Medicaid programs do not provide reimbursement for the D0350 (2D oral/facial photographic image obtained intra-orally or extra-orally) procedure code.

 

Last month the Ohio Dental Association began contacting the ODM, Medicaid HMOs and Ohio based dental insurers about coverage of the D0140 code when provided via teledentistry after restrictions were placed on the state’s dental profession in order to preserve personal protective equipment (PPE) and supplies and reduce the risk of patients’ exposure to COVID-19. In making its announcement, ODM noted it had consulted with and obtained guidance from the ODA, American Dental Association and Ohio State Dental Board as it worked to develop the emergency rules.

 

Billing instructions and additional information about Ohio Medicaid’s new telehealth rules may be accessed by clicking here.