During the outbreak of the coronavirus, or COVID-19, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is covering the cost of telemedicine for our members. The information below provides information regarding tele-dentistry services covered under Blue Cross NC dental plans.
- There are specific oral surgery procedures categorized as medical services in the member medical benefit booklet. This information is not intended to address claims for services covered under medical plans, only for dental plans. For guidance on coding and claims submission for these specific medical procedures, please refer to our COVID-19 medical telehealth communications.
- For guidance on all other dental procedures covered under medical plans, please refer to our COVID-19 dental telehealth communications.
- Providers offering tele-dentistry can perform certain evaluations and consultation services virtually, through two-way, live audio-visual telecommunications, using a computer, tablet, or mobile phone.
- Tele-dentistry services fall under the preventive and diagnostic benefit category, which is typically covered at 100% of the allowed amount.
- Participating providers agree not to bill patients for amounts above the contracted rate of covered services.
- Non-participating providers may hold patients responsible for amounts above the allowed amount.
- Blue Cross NC's Dental Blue members can expect the same excellent customer service, service hours, and claims processing they're used to. Our business continuity plan supports all business capabilities to answer calls about benefits and claims and accept and process claims.
- This chart can answer some of your questions about how Blue Cross NC's Dental Blue plans cover tele-dentistry services:
|Plan Type||Is Blue Cross NC covering limited, problem-focused evaluations performed using telecommunication technology?||Is Blue Cross NC covering a consultation with the patient’s physician?||Will Blue Cross NC waive frequency limits on evaluations that may be needed face-to-face later in the year, even if the following codes are used via telecommunication technology?|
|Applicable Service Codes
Commercial Dental- Dental Blue
Blue Cross NC will reimburse for D0140 and D0170 services when performed via tele-dentistry the same as when performed in a traditional setting. There is no additional benefit for the D9995 and D9996 codes; however, these codes should be used as modifiers to document how the services were provided.
Post-operative re-evaluation visits (D0171) are not a covered service; they are included in the fee for the original procedure.
No. Our frequency limitation is two per benefit period to allow maximum flexibility for both the member and provider. D0140, D0160, and D0170 count toward the two per benefit period limit, regardless of the encounter type.Other frequency limits for services such as a routine exam or prophylaxis are also covered on a “per benefit period” basis for flexibility in scheduling for providers and patients.
- These quick tips can help you with filing Dental Blue tele-dentistry claims:
- Include D9995/D9996 as modifiers. That is all that is needed to indicate the services were provided via tele-dentistry.
- For section 38, use "11" as your provider's office location ("Place of Service").
- For section 56, use the physical address of the treating provider’s office ("Address for Treating Provider’s Location").
Please contact Dental Customer Service at 800-305-6638.