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Pennsylvania Medicaid (DHS)Medicaid · Billing Codes · Provider Bulletin · PA · DentistryMedium impact

MAB2022061301

Effective date
May 2, 2022
Identified
Jun 20, 2026

Summary

Pennsylvania Medical Assistance dentists, Federally Qualified Health Centers and Rural Health Clinics may provide teledentistry, which is two-way, real time interactive communication between the patient and dentist, for dates of service on and after May 2, 2022. Procedure codes D0140, D1206 and D1320 can be provided via teledentistry, and procedure code D9995 was end-dated on May 1, 2022, so providers use Place of Service 02 to indicate teledentistry services. Procedure codes D1310 and D1330 were added to the MA Program Dental Fee Schedule effective May 2, 2022 and must be rendered to the beneficiary during a single visit with a combined total of at least 12 minutes.

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What to do

Action · 8 steps
01Already effective May 2, 2022: Providers use Place of Service 02 to indicate teledentistry services, because procedure code D9995 was end-dated on May 1, 2022.
02FQHCs and RHCs continue billing procedure code T1015 with the U9 modifier for dental visits or encounters rendered via teledentistry, and stop using the GT modifier as of May 2, 2022 with POS 02.
03Procedure codes D0140 and D1320 are the only services that may be provided using audio only; for audio-only services, providers document that the service was rendered using audio-only technology and the reason audio/video technology could not be used.
04Procedure code D0140 by teledentistry is limited to urgent situations such as pain, infection, excessive bleeding or trauma, and must be initiated by the patient calling the provider's office.
05Other teledentistry services must use audio/video technology.
06Providers obtain consent from the beneficiary or legal guardian before rendering a service via teledentistry, do not record the service without the beneficiary's consent, and document the services rendered and the telecommunication technology used in the beneficiary's medical record.
07Teledentistry services are paid at the rate on the MA Program Dental Fee Schedule, with no additional payment for the technology.
08Check current applicability before acting on these dates.

Codes mentioned

D0140D1206D1320D1310D1330D9995T1015

Original notice

MAB2022061301
pa.gov · Always check the source before changing claims.
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Related changes

See all Pennsylvania Medicaid (DHS) changes →
MAB2023102301MediumEffective Sep 5, 2023 · Provider BulletinMedical Assistance Program Dental Fee Schedule and Dental Provider Handbook Update MAB 27-19-17MediumEffective Aug 19, 2019 · ReimbursementMAB2021113001MediumEffective Aug 23, 2021 · Provider BulletinMAB2023083101MediumEffective Sep 5, 2023 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list

Related policy hubs

Pennsylvania Medicaid (DHS) policiesPA policy changesDentistryCode D0140Code D1206Code D1320Code D1310Code D1330Code D9995Code T1015

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