In response to COVID-19 emergency measures, Envolve Dental, Inc. (a Centene Corporation subsidiary) will cover CDT codes D0140, D0170, D0171, and D0350 when reported with teledentistry codes D9995 or D9996, as applicable. Envolve Dental encourages providers to refer to current CMS and CDC guidance, as well as any applicable state directives, on the type and nature of care that should be rendered during this time; specifically referencing, but not limited to, benefit eligibility for codes D0140, D0170, D0171, and D0350 when reported with teledentistry codes D9995 and D9996. Providers may use appropriate audio and/or visual communication channels (e.g., FaceTime, Skype, Zoom) to conduct their teledentistry services; however, we ask that providers ensure HIPAA protocol is upheld where possible. In cases where compliance is not possible, patients should be notified of this risk. Envolve will not pursue penalties where a good faith effort is made by the provider to comply with HIPAA rules.
Each teledentistry patient interaction must be thoroughly documented in the patient’s record, which should include screen capture images or other diagnostic information pertaining to the patient’s condition. This patient information must be entered and retained in the patient record in the event that records are reviewed in the future. When submitting a request for payment for these services, either D9995 or D9996 must be included to identify the service as being provided via teledentistry. Envolve Dental will pay D9995 and D9996 at established state fee schedule rates, if available. In the absence of respective state rates, D9995 will be reimbursed at $12.27 and D9996 will be reimbursed at $14.80.
Envolve Dental will waive member liability for services provided via teledentistry during the COVID-19 crisis. Members enrolled in a High Deductible Plan (HSA) will still incur member liability with the exception of the treatment for COVID-19.
Envolve Dental’s teledentistry policy applies to the following market products: Medicaid, Medicare, Medicare Advantage, Marketplace. It is limited in time to the shorter of 90 days or the lifting of COVID-19 emergency measures limiting dental services to emergency services only.
Please check our Provider Web Portal for periodic updates: envolvedental.com/logon