D9995 Dental Code: Synchronous Teledentistry Billing Guide

What D9995 covers

D9995 reports that a dental encounter happened live. People at the patient’s location, which might be the patient alone at home or a hygienist working chairside in a school, nursing home, or mobile setting, are connected in real time to a supervising or consulting dentist somewhere else. The connection carries both audio and video, the interaction is continuous while it happens, and everyone involved can see the same thing and talk about it as it unfolds.

That last part is the code. The dentist is not reading a chart after the fact. The dentist is present, remotely, while the case is in front of someone.

Two things follow from that, and both change how the claim is built:

• D9995 is an adjunct, not a service. The ADA’s guidance treats teledentistry as a mode of delivery, reported alongside whatever clinical procedures the patient actually received that day. It gets its own claim line next to the evaluation and imaging lines, never in place of them.
• One teledentistry line per encounter, one per patient. Quantity on the line cannot exceed one, and only one type of teledentistry may be reported for an encounter. The ADA’s guidance reports D9995 once per patient on the date of service, the same way D9410 is reported once per date of service when the dentist travels to a home or long-term care facility.

There is no CDT code for capturing, transmitting, or receiving the information itself. Those steps live in the chart note.

D9995 against the codes it gets confused with

Four codes turn up in this conversation, and only two of them describe delivery mode at all.

The teledentistry pair, split on timing.

• D9995 is synchronous. Live, two-way, real-time audiovisual interaction, with the remote dentist participating while the encounter happens.
• D9996 is asynchronous. Records are stored and forwarded through a secure connection, and the dentist reviews them later with no live contact.

The axis is real time versus later. It is not video versus photographs, and it is not office versus remote. A dentist watching a hygienist’s intraoral camera feed live and a dentist opening those same images the next morning are billing two different codes for the same images.

The two codes that answer a different question.

• D9310 is a consultation, a diagnostic opinion rendered by a dentist or physician other than the one who asked for it. That is a statement about who provided the opinion, not about how the encounter was delivered. A specialist can render that opinion over a live connection, so D9310 and D9995 can appear on the same claim.
• D9430 reports a patient coming into the office during normal hours purely to be looked at, with no other service done that day. It requires that nothing else was billable. D9995 requires that one was. They are structural opposites, and neither is a fallback for the other.

Deciding whether the encounter is a D9995

1. Was there live, two-way contact while the encounter was happening? With both audio and video. If the dentist only saw the records afterward, the code is D9996 instead.
2. Did the dentist render a service? An oral evaluation, a diagnosis, a treatment plan. The dentist who oversees the event and completes the evaluation is the one who documents and reports the teledentistry code.
3. What clinical codes are going on the claim? Usually an evaluation such as D0120, D0140, or D0170, often with imaging or photographs such as D0220, D0230, or D0350. The ADA’s own real-time scenario also reports D0801, the direct 3D intraoral surface scan, alongside the assessment and photographic codes, since a chairside scanner is exactly the kind of capture a remote dentist can watch happen. Those lines are the claim. D9995 rides with them.
4. Does the payer’s own definition fit this encounter? Some definitions assume a caregiver is physically with the patient. North Dakota Medicaid, for one, describes synchronous teledentistry as live interaction between the patient and at least one dental, medical, or health caregiver at one location and an overseeing dentist at another. A dentist on video with a patient sitting alone at home clears the ADA’s description but may not clear a payer’s. Read the definition in the policy, not just the code.
5. Is this a dental claim? The ADA is explicit that D9995 and D9996 apply only to claims filed against a dental benefit plan. A medical plan uses a different form, different code sets, and its own instructions.

Coverage and how carriers treat it

Teledentistry coverage sits on top of state practice acts, state Medicaid policy, and individual plan design all at once, so it fragments more than most adjunctive codes. Verify per payer and per state rather than carrying one rule across the book.

The line often pays zero on purpose. Delta Dental of Minnesota considers the fees for D9995 and D9996 inclusive in overall patient management and states they are not billable to the patient. Read the second half of that before posting a balance. Other payers do reimburse: South Dakota Medicaid pays teledentistry at the same rate as the equivalent in-person visit.

A live encounter can carry a second claim the asynchronous one cannot. South Dakota Medicaid pays an originating-site facility fee to enrolled dental providers, a dental office, FQHC, RHC, or IHS facility among them, for hosting the patient while a covered teledentistry service is delivered from the distant site. It is billed as HCPCS Q3014 on a CMS 1500 or 837P rather than on the dental claim, and it is rated on the physician fee schedule. Asynchronous encounters are explicitly not eligible for it. That is the one place where the D9995 versus D9996 call changes what money is on the table rather than just which code gets reported. The program adds that nothing extra is paid for equipment, technicians, technology, or personnel on top of that fee, and that other kinds of sites may host an encounter without qualifying for it.

State programs publish closed lists of eligible services. South Dakota Medicaid names the CDT codes it covers by teledentistry, running from evaluations such as D0120, D0140, D0145, and D0150 through radiographic images including D0210, D0220, D0272, and D0330, and states that codes off the list may not be delivered that way. North Dakota Medicaid publishes a shorter list built around evaluation and assessment codes. The two lists do not match each other, which is the whole point.

Frequency is usually once per date of service. North Dakota Medicaid requires D9995 or D9996 on a teledentistry claim and reimburses it once per date of service, matching the ADA’s cap of one on the quantity field.

Place of service is a live denial reason. The ADA instructs dentists to report POS 02 in Item 38 and to check whether the plan wants a different value. Its guide is not self-consistent here, naming 02 and then adding that the place of service should match what would have been reported had the visit happened in person, with POS 11 for the office as its example. Take 02 as the starting point and the plan’s own written instruction as the one that controls. North Dakota Medicaid splits it, using 02 when the patient is somewhere other than home and 10 when the patient is at home, and denies claims carrying anything else. Place of service is reported at claim level on dental claims, so it applies to every line on the submission.

Some programs cap the encounter’s own scope. South Dakota Medicaid limits reimbursement to one reading or interpretation of a diagnostic test per visit, does not separately reimburse the transmission of materials, and restricts providers who primarily or only see its recipients by teledentistry to the limited oral exam.

Documentation that supports the claim

The claim line alone does not prove a live encounter took place, so the record has to.

• The platform used. South Dakota Medicaid asks specifically for the name of the platform when the visit was synchronous. That single detail is what separates a documented video encounter from a phone call in an auditor’s eyes.
• Everyone involved and their role. Names and credentials of each person in the event, including whoever was with the patient, plus what each of them did.
• A note that the interaction was live. The ADA requires the patient record to carry the code reflecting the type of teledentistry encounter. Say plainly that the dentist participated in real time over audio and video.
• The date the procedures were delivered. The ADA’s instruction for Item 24 is the date the procedures in the encounter were performed.
• The dentist’s findings. The evaluation, diagnosis, and treatment plan. That is the substance behind the payable line and the thing a carrier auditing a teledentistry claim actually reads.
• Licensure across state lines. The ADA points to state law, regulation, and licensure as controlling when the dentist and the patient are in different states. Confirm it before the encounter, not on appeal.

What to get right in your PMS

Open Dental, Dentrix, Eaglesoft, Curve, and Carestream handle this the same way underneath: a procedure code that has to reach the claim with no tooth attached.

1. Set D9995 and D9996 up as separate procedures with a real fee. The ADA’s instruction for the fee field is the full fee for the teledentistry procedure, which is what it costs the practice to run the technology behind the encounter. Even when a plan bundles it, the fee has to be on the claim to be adjudicated.
2. Leave the tooth fields empty. Area of the oral cavity, tooth system, tooth numbers, and tooth surface are all unused on the teledentistry line. A template that forces a tooth entry will kick the claim.
3. Fill in the description field. The ADA’s completion instructions want the line labeled by modality, synchronous or asynchronous, so the carrier can see which one was reported without decoding the code.
4. Get place of service onto the claim. POS is a claim-level property on dental claims, not a procedure attribute, so find where your software sets Item 38 before the first teledentistry claim goes out.
5. Confirm Item 56 shows the practice address. The treatment location on a teledentistry claim is the dentist’s practice location, not wherever the patient was sitting. It has to be a street address.
6. Keep a per-payer note of eligible codes and definitions. Which evaluations and images a plan or state program allows by teledentistry, and how that payer defines a synchronous encounter, is what decides whether the claim pays. Store it with the plan’s frequency notes so verification catches it before the visit.
7. Decide the write-off rule in advance. Bundled teledentistry lines will keep coming back at zero. Put the posting rule in the collections notes so every account is handled the same way.

For how the service lines, place of treatment, and treating-dentist blocks are filled in on the claim itself, see the ADA dental claim form guide.