DHS COVID-19 PROVIDER RESOURCES // OMAP
Provider Quick Tips: Teledentistry
Guidelines Related to COVID-19 for
Federally Qualified Health Centers,
and Rural Health Clinics
Issued: April 7, 2020
On March 6, 2020, Governor Wolf issued an emergency disaster declaration in response to the presence of
the COVID-19 (coronavirus) in Pennsylvania.
Additionally, on March 26, 2020, the Department of Health (DOH) issued revised Guidance on COVID-19
for Dental Health Care Personnel in Pennsylvania, which directs facilities to cease all dental treatment
except urgent and emergency procedures. The guidance further encourages the use of teledentistry when
Teledentistry is two-way, real time interactive communication between the patient and the dentist.
Teledentistry may be provided by any means that allows for two-way, real-time interactive
communication, such as through audio-video conferencing hosted by a secure mobile application. During
this state of emergency, telephone only services may be utilized in situations where video technology is
The Department of Human Services (DHS) recognizes a medical professional may not be available at the
same location as the beneficiary, therefore, during COVID-19 emergency, there is no requirement for a
dentist or dental professional to be physically present at the originating site, where the member is located.
Pursuant to the Governor's disaster declaration and the DOH's guidance, and in accordance with
the Centers for Disease Control and Prevention’s (CDC’s) recommendations related to quarantine and
isolation, both self-imposed and mandatory, DHS is issuing this guidance to advise all dentists (all
specialties) and Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) with dental
services in their approved Scope of Project, that teledentistry may be used to provide medically necessary
dental services to Medical Assistance (MA) Program Fee-for-Service beneficiaries and Physical Health
Teledentistry should be used to assess whether a member has an urgent or emergent dental condition
that can be treated during that encounter via teledentistry or whether the member should be seen in the
office setting in accordance to DOH guidance.
This teledentistry policy does not apply to dental hygienists, Public Health Dental Hygiene Practitioners,
or other dental staff.
Effective, with dates of service March 1, 2020 and after, procedure code D9995, defined as "teledentistry
- synchronous" is being added to the MA Program Dental Fee
Schedule to indicate that a dental visit was rendered remotely by a dentist (all specialties) using
teledentistry. Procedure code D9995 may only be used in conjunction with procedure code D0140,
defined as "limited oral evaluation - problem focused" for a visit provided via teledentistry to patients
who are experiencing true emergencies related to pain, infection, excessive bleeding and trauma.
Dentists are to bill procedure code D9995 with procedure code D0140 when billing for a teledentistry visit.
Services rendered via teledentistry using procedure code D0140 will be paid at the rate listed on the MA
Program Dental Fee Schedule. No additional payment will be made for the technology. In addition,
dentists are to document in the beneficiary’s record that the service was rendered via teledentistry.
Effective with dates of service on and after March 1, 2020, FQHCs and RHCs are to bill procedure code
T1015 with the U9 and GT modifiers to indicate dental visits/encounters rendered via teledentistry to
patients who are experiencing true emergencies related to pain, infection, excessive bleeding and trauma.
MA MCOs will also cover remote dental visits and encounters. MA MCOs will pay dentists according to
their negotiated rates. MA MCOs must pay FQHCs and RHCs at least the MA Fee-for-Service Prospective
Payment System (PPS) rate for a dental encounter.
The MA program requests providers billing medical claims in the institutional format to identify claims
that are or may be impacted by specific policies related to the COVID-19 disaster with a DR (disaster
related) condition code. Providers submitting medical claims using the professional claim format should
use a CR modifier to identify claims that are or may be impacted by specific policies related to the COVID19 disaster. The use of the DR condition code and the CR modifier is required when submitting a medical
claim for which the payment is conditioned on the presence of the 1135 waiver. The following is a link to
the 1135 waiver letter and checklist to provide further guidance on when the DR and CR should be used.
This guidance will remain in effect for the duration of the Governor's disaster declaration relating to the
COVID-19 virus. DHS may re-issue these guidelines as appropriate.
Information on MA Program coverage related to COVID-19, including a FAQ document, can be found
on the DHS website.
DOH has a dedicated page for COVID-19 that provides regular updates. Click here for the most up to date
information regarding COVID-19.