Or. Admin. Code § 410-123-1265

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-123-1265 - Teledentistry

(1) Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to:

(a) Live video, a two-way interaction between a member and dentist using audiovisual technology;

(b) Store and forward, an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the member being present in real time;

(c) Remote member monitoring, where personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care; and

(d) Mobile communication devices such as cell phones, tablet computers, or personal digital assistants may support mobile dentistry, health care, public health practices, and education.

(2) All billing requirements stated in this rule apply to all delivery modalities referenced in section (5) of this rule.

(3) Billing Provider Requirements, as referenced in OAR 410-120-1990:

(a) Dentists providing Medicaid services shall be licensed to practice dentistry within the State of Oregon or within the contiguous area of Oregon and shall be enrolled as a Health Systems Division (Division) provider;

(b) Providers billing for covered teledentistry/telehealth services are responsible for the following:

(A) Complying with Health Insurance Portability and Accountability Act (HIPAA) and Oregon Health Authority (Authority) Confidentiality and Privacy Rules and security protections for the patient in connection with the telemedicine communication and related records. See OAR 410-120-1990;

(B) Obtaining and maintaining technology used in the telehealth communication that is compliant with privacy and security standards in HIPAA and Department Privacy and Confidentiality Rules described in subsection (5)(b)(A) of this rule;

(C) Ensuring policies and procedures are in place to prevent a breach in privacy or exposure of member health information or records (whether oral or recorded in any form or medium) to unauthorized individuals;

(D) Maintaining clinical and financial Documentation related to telehealth services as required in OARs 410-120-1360 and 410-120-1990.

(c) A member receiving services through teledentistry shall be notified of the right to receive interactive communication with the distant dentist and shall receive an interactive communication with the distant dentist upon request;

(d) The member's chart Documentation shall reflect notification of the right to interactive communication with the distant site dentist;

(e) A member may request to have real time communication with the distant dentist at the time of the visit or within 30 days of the original visit.

(4) General Billing Requirements:

(a) Unless authorized in OAR 410-120-1200 Exclusions or OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered:

(A) When those types are not being used in lieu of teledentistry, due to limited teledentistry equipment access; or

(B) When those types and specific services are not specifically allowed in this rule per the Oregon Health Evidence Review Commission's Prioritized List of Health Services.

(b) The dentist may bill for teledentistry on the same type of claim form as other types of procedures unless in conflict with the Dental Services rules;

(c) All Dental Services rules, criteria, and limits apply to teledentistry services in the same manner as other services;

(d) As stated in ORS 679.543 and this rule, payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

(5) Teledentistry billing requirements:

(a) The dentist who completes diagnosis and treatment planning and the oral evaluation also documents these services using the traditional CDT codes. This provider also reports the teledentistry event using D9995 or D9996 as appropriate. See the Dental Billing Instructions for details at: www.oregon.gov/oha/HSD/OHP/Pages/Policy-Dental.aspx;

(b) The originating site may bill a CDT code only if a separately identifiable service is performed within the scope of practice of the practitioner providing the service. The service shall meet all criteria of the CDT code billed.

(6) An assessment D0191 is a limited inspection performed to identify possible signs of oral or systemic disease, malformation or injury, and the potential need for referral for diagnosis and treatment. This code may be billed using the modality of teledentistry:

(a) When D0191 is reported in conjunction with an oral evaluation (D0120-D0180) using teledentistry, D0191 shall be disallowed even if done by a different provider;

(b) The assessment and evaluation may not be billed or covered by both the originating site dental care provider and a distant site dentist using the modality of teledentistry, even if due to store-and-forward review, if the dates of services are on different days.

Or. Admin. Code § 410-123-1265

DMAP 119-2018, adopt filed 12/26/2018, effective 1/1/2019; DMAP 61-2020, amend filed 12/11/2020, effective 1/1/2021; DMAP 50-2021, amend filed 12/24/2021, effective 1/1/2022; DMAP 66-2024, minor correction filed 02/21/2024, effective 2/21/2024

Statutory/Other Authority: ORS 679.543 & ORS 414.065

Statutes/Other Implemented: ORS 414.065