MedicaidCoverageHigh impact
Newsletter Vol. 33, No.13
New Jersey Medicaid·NJ · Dentistry·Provider Notice
Effective date
Jul 1, 2023
We identified it
Jun 20, 2026
Summary
Effective July 1, 2023, New Jersey Medicaid/NJ FamilyCare has restricted synchronous teledentistry (CDT code D9995) to only three patient populations: individuals with intellectual and developmental disabilities, those enrolled in MLTSS, and homebound individuals. Teledentistry must now be billed with CDT code D0140 (limited oral evaluation – problem focused) on the same claim, and requires strict compliance with technology standards (minimum 384 kbps bandwidth, real-time audio/video), patient authentication, and provider availability protocols.
Action Required
By July 1, 2023 (retroactively, as this policy is 1 month old): Billing team must immediately implement the following: (1) Restrict D9995 billing to ONLY patients with intellectual/developmental disabilities, MLTSS enrollment, or homebound status—implement eligibility verification in billing system before claim submission; (2) Require D9995 and D0140 to be billed together on the same date of service claim for all other providers, or D0120 (with modifier 22) plus D9995 plus D0140 for Federally Qualified Health Centers; (3) Update provider templates and encounter forms to enforce simultaneous coding; (4) Train clinical and administrative staff that teledentistry claims without the required companion code will be denied; (5) Educate providers that teledentistry must meet 384 kbps minimum bandwidth, real-time audio/video standards, and cannot use audio-only calls, email, fax, or text as standalone services; (6) Notify all contracted dentists and FQHCs of the new restrictions and verify patient eligibility before scheduling teledentistry encounters. Verify with managed care plans regarding their specific requirements, as they may differ. Failure to comply will result in claim denials and potential overpayment recovery.