COVID-19- Temporary Dental Services Policy
On Friday, March 13, 2020, President Donald Trump declared a national emergency due to coronavirus disease 2019 (COVID-19) and Governor Henry McMaster declared a state of emergency for the state of South Carolina. As a part of the state’s preparation and response to COVID-19, the South Carolina Department of Health and Human Services (SCDHHS) is announcing additional temporary modifications to policies related to services eligible for reimbursement through the dental benefit.
SCDHHS will begin accepting claims for the changes noted below no later than April 15, 2020, for dates of services on or after this bulletin’s date. These temporary changes will be in effect for the duration of the federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency. Benefit limitations, criteria and documentation required for these temporary services are detailed in Appendix C of the Dental Services Provider Manual, available on SCDHHS’ website.
Patient Triage and Care Coordination via Telephonic or Telehealth Encounter
SCDHHS will reimburse enrolled dentists for the provision of triage and care coordination when provided via telephonic or telehealth interaction for patients with urgent or emergent dental issues, regardless of the patient’s location. Dentists should bill for these services using Current Dental Terminology (CDT) procedure code D9992. Reimbursement for D9992 will be allowed once per 30 days.
Oral Evaluation
CDT Code D0140- Limited, problem-focused exam
SCDHHS will allow one CDT code D0140 billing per 30 days for established patients as face-to-face or via telemedicine. The service is not allowed within 30 days of billing CDT code D0160, if conducted by the same provider.
CDT Code D0160- Detailed and extensive oral evaluation, problem-focused
SCDHHS will reimburse enrolled dental providers accepting new patients for the purpose of providing urgent or emergent dental care, using CDT code D0160. SCDHHS will allow one CDT code D0160 billing for each new patient. CDT code D0160 should be billed only for face-to-face care of new patients.
Interim Caries Arresting Medicament Application
To encourage the temporary transition from aerosol-producing to non-invasive dental procedures, as recommended by the American Dental Association (ADA), SCDHHS will reimburse for the application of caries arresting medicament, Silver Diamine Fluoride 38% (SDF) on both primary and permanent teeth. Dental providers may bill CDT code D1354 for one application, per six months, per tooth, per patient. SDF must be billed in conjunction with a periodic, problem-focused or comprehensive dental exam. Application of caries arresting medicament for tooth sensitivity or as an adjunctive procedure will not be reimbursed.
Limitations and Clarification
Reimbursement for the telephonic services described above is available if the interaction with a Healthy Connections Medicaid member includes at least one telephonic component. Interactions that also include video interaction may also be billed, but other forms of electronic communication, such as email and instant and text messaging, are not eligible for reimbursement. To qualify for reimbursement, patient interactions must include the necessary audio and video components, of sufficient quality and resolution, to provide the care that is being billed.
Families and beneficiaries should be given every opportunity to make informed decisions about the receipt of services via telemedicine, including the clinical appropriateness of the intervention, its limitations, privacy and confidentiality and the effect the provider’s setting has on each of these issues.
Any additional guidance regarding coverage policy will be communicated in future bulletins, as needed. For questions regarding this bulletin and the South Carolina Healthy Connections dental benefit, please contact the DentaQuest Provider Call Center at (888) 307- 6553.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.