Use of Teledentistry in Commercial Dental Treatments

Overview

Throughout the COVID-19 Crisis, P&R Dental Strategies® will be marshaling our entire arsenal of dental data and analytical firepower, and deep dental domain expertise, to help all dental market stakeholders better understand what’s happening, what to consider, and to answer specific questions we’ve been asked by our clients and colleagues in the market. We plan to produce and share other Coronavirus Impact Insights analyses as the situation develops.

P&R Dental Strategies’ data-driven insights are derived from our various data resources, including DentaBase®, our ever-expanding proprietary multi-payer database, which contains over 3.5 billion dental procedure records from 66 national and regional commercial dental insurance payers. DentaBase contains statistically significant utilization, financial and claim review data on over 190,000 US dentists covering 70+ million commercial insurance members and enables us to provide keen, actionable insights that are not available from other sources.

Question: What are the implications of the developing COVID-19 state mandates on the use of Teledentistry in Commercial Dental Treatments?

Our Chief Dental Officer, Dr. Michael Fiorenza, in collaboration with the P&R Dental Strategies clinical team, has evaluated the types of services that might be delivered through Teledentistry in the current situation.

D9995 – teledentistry – synchronous: real-time encounter	The scope of services will generally be limited in one-on-one direct communications between the dental office and the patient to some form of exam/consultation.
D9996 – teledentistry – asynchronous: information stored and forward to dentist for subsequent review	The scope of services are generally limited to triage, exam, and diagnostics. Traditionally, this is used either for oversight of mobile field teams or consultation support and involves additional mobile treatment and diagnostic capabilities.

“Telehealth is not a specific service; it refers to a broad variety of technologies and tactics to deliver virtual medical, health, and education services.”

— Source: D9995 and D9996 ADA Guide – Version 1 – July 17, 2017 ©2017 American Dental Association (ADA). All rights reserved

The Teledentistry procedure codes are “reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service”.

D9995 The scope of services will generally be limited in one on one direct communications between the dental office and the patient to some form of exam/consultation. D9995 is the Teledentistry code most commonly not covered in traditional commercial dental plans, with no benefits paid in 2018 or 2019.

D9996 The scope of services are generally limited to triage, exam, and diagnostics. Traditionally, this is used either for oversight of mobile field teams or consultation support and involves additional mobile treatment and diagnostic capabilities. D9996 has an equally small volume with a small percentage of services with any level of benefits paid in 2018 or 2019.

The most likely companion CDT code is D0140 – limited oral evaluation – problem focused.

Since the Coronavirus Crisis began, our GroupPracticeIQ® research team has reviewed a sample of websites of individual dentist offices across the country this week for developing trends.

Our teams will be monitoring this more closely and we’ll provide additional insight as it becomes available.

What does the historical utilization of Teledentistry look like?

Our Chief Analytics Officer, Tim Downey, analyzed all procedures in DentaBase in 2019 and determined that claims relating to Teledentistry submitted to commercial dental plan treatments in 2019 represented far less than 1% of the overall treatments submitted in 2019.

• Less than 1% of treated commercial patients had one or more Teledentistry services
• ~1% of active dentists submitted any fees for Teledentistry services.

P&R Dental Strategies will continue to monitor and report on the volume of Teledentistry services being delivered during the Crisis.

*Note: Current Dental Terminology © American Dental Association

Historical Volume

Teledentistry codes D9995 and D9996 were “limited volume,” for commercially insured patients nationally in 2019 — meaning there were fewer than 5,000 procedures overall.

Public dental benefit programs are not included in this review and the role of Teledentistry in public programs varies by state. There is evolving federal guidance on the use of Teledentistry and the American Dental Association issued an update brief on March 25, 2020: COVID-19 Coding and Billing Interim Guidance.

The Volume in 2020 Remains Very Low

• The volume of Teledentistry services was higher in 2018 following the release of the Teledentistry codes but dropped in 2019.
• YTD 2020 Teledentistry services have remained very low (even lower than 2019) prior to the current Crisis.
• 13% of the submitted dollars were paid overall across DentaBase in 2019. Benefits were paid on 13% of the submitted fees for Teledentistry overall across DentaBase® in 2019.
• 39% of the 2020 YTD Teledentistry treatments have dates of service in the last two weeks (March 9, 2020 thru March 20, 2020).

Based on DentaBase, the national average of unique commercial patients receiving Teledentistry services in 2019 was less than 100 per month. The monthly average for unique commercial patients receiving Teledentistry services in January and February 2020 is even less.

Geographic Distribution in 2019

Based on DentaBase, the patients receiving Teledentistry services in 2019 originated from virtually every state in the US. Only six states have no 2019 commercial Teledentistry services: Alaska, Idaho, Montana, Wyoming, North Dakota, and Vermont. Every other state has at least one. The highest percentage of the patients were in California.

Similarly, at least one dentist provided Teledentistry services in all but six US states. However, the greatest number of unique dental providers submitting claims for teledentistry services YTD in 2020 are in California, Texas, Florida, Illinois and New York.

Do you have questions about this analysis or anything else? Submit a question for discussion: ASK A QUESTION

Discussion

No discussion to share yet.