D9996 Dental Code: Asynchronous Teledentistry Billing Guide

What D9996 covers

D9996 reports that a dental encounter happened asynchronously. A hygienist in a school or long-term care setting, another auxiliary, or the patient’s own device captures records: periapicals, intraoral photographs, digital scans, charting, health history, consent, progress notes. The records go through a secure, HIPAA-compliant connection to a dentist, who reviews them later and completes the evaluation, diagnosis, and treatment plan.

The defining feature is the absence of live contact. Nobody at the patient’s location is talking or on video with the reviewing dentist while the records are gathered.

• D9996 is an adjunct, not a service. The ADA states it is reported in addition to the other procedures delivered to the patient on that date of service. It gets its own claim line next to the evaluation and imaging lines, never in place of them.
• One teledentistry line per encounter. Quantity cannot exceed one, and only one type of teledentistry may be reported for an encounter, so D9995 and D9996 never appear together on the same encounter.

There is no CDT code for collecting, transmitting, or receiving the records. Those steps go in the chart note, and South Dakota Medicaid confirms that transmission of materials is not separately reimbursable.

D9996 against the codes it gets confused with

Four codes come up here, and only two describe delivery mode.

The teledentistry pair, split on timing.

• D9995 is synchronous: live, two-way audiovisual interaction, with the dentist able to see and discuss the case as it happens.
• D9996 is asynchronous: records are stored and forwarded, and the dentist reviews them outside any live interaction.

The axis is real time versus later, not video versus photos and not office versus remote. A dentist watching a hygienist’s intraoral camera feed live and a dentist opening the same images the next morning bill two different codes.

The two codes that answer a different question.

• D9310 is a consultation, a diagnostic opinion from a dentist or physician other than the one who requested it. It describes who, not how the information traveled. Store-and-forward is a common way to run a consultation, so the two codes can be on the same claim.
• D9430 is an office visit for observation during regular hours with no other services. It requires that nothing else was billable; D9996 requires that something was. Neither describes a remote encounter, and swapping in D9430 when a virtual check-in produced no findings does not create a payable claim.

Deciding whether the encounter is a D9996

1. Was there live two-way contact during the encounter? If yes, the code is D9995. If the dentist only saw the records afterward, it is D9996.
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 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 such as D0220, D0230, or D0350. Those lines are the claim; D9996 accompanies them.
4. Does the plan allow those codes by teledentistry? State programs in particular publish closed lists. Confirm before the records are captured.
5. Is this a dental claim? D9996 has no place on a medical claim.

Which date of service goes on the claim

Store-and-forward is the one teledentistry situation where the encounter has two dates. Records are captured on a Tuesday at a nursing facility, the dentist opens them on Friday and completes the evaluation, and the claim needs a date.

The ADA’s instruction for Item 24 on the teledentistry line is the date the procedures in the encounter were performed, not the date the dentist reviewed them. The capture date anchors the lines for what happened at the patient’s location, and the teledentistry line sits alongside them.

The date for the dentist’s own evaluation is genuinely unsettled. The ADA’s asynchronous scenario splits the reporting: the auxiliary’s assessment and images on one side, the dentist’s oral evaluation and D9996 on the other. The guide adds that more than one claim submission may be needed when care starts at a remote location and continues at the practice, or when a state practice act lets different licensed practitioners bill the services they personally provided. It gives no single rule for which date a later evaluation carries, so get each payer’s answer before the first claim.

Two things are settled:

• The teledentistry line shares a date with the services it accompanies. South Dakota Medicaid requires D9995 or D9996 to be reported with the codes for the services provided on the date of service, and North Dakota Medicaid reimburses the teledentistry code once per date of service.
• Timely filing runs from the service date, not the review date. South Dakota Medicaid allows 6 months following the month the service was provided; North Dakota Medicaid allows 180 days from the date of service. Records that sit unopened for weeks use up that window.

Coverage and how carriers treat it

Teledentistry coverage depends on state practice acts, state Medicaid policy, and individual plan design at once. Verify per payer and per state.

The line often pays zero by design. Several carriers treat the teledentistry code as inclusive of the exam. Delta Dental of Minnesota considers the fees for D9995 and D9996 inclusive in overall patient management. Other payers pay: South Dakota Medicaid reimburses teledentistry at the same rate as the equivalent in-person visit.

Some programs publish a closed list of eligible services. South Dakota Medicaid names the CDT codes it covers by teledentistry, mostly evaluations and radiographic images, and codes not on the list may not be provided that way. It also instructs providers not to put non-covered teledentistry services on the same claim as D9995 or D9996. North Dakota Medicaid’s list, as of its January 2026 manual, runs to evaluation and assessment codes including D0120, D0140, D0145, D0170, D0171, D0190, and D0191. The two lists do not match, so keep a per-payer note of eligible codes.

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

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 something else. North Dakota Medicaid uses 02 when the patient is somewhere other than home and 10 when the patient is at home, and denies any other value.

Some exclusions target specific modalities. North Dakota Medicaid does not cover audio-only contact with the consulting dentist or a virtual check-in. A store-and-forward encounter built on images clears that bar; a phone call does not.

Documentation that supports the claim

The record has to show the mode of delivery, because the claim line alone does not prove it.

• Which modality was used. State that the encounter was asynchronous and the dentist reviewed stored records rather than interacting live. The ADA requires the patient record to reflect the type of teledentistry encounter.
• Who was involved and in what role. Names and credentials of everyone in the event, including whoever captured the records. South Dakota Medicaid asks for exactly this.
• The capture and transmission steps. With no CDT code for them, the note is the only record that they happened and that the connection was secure.
• When each step happened. The capture date and review date usually differ, and the chart note is the only place that gap is recorded. The claim line carries the date the procedures were performed.
• The dentist’s findings. The evaluation, diagnosis, and treatment plan, which are what a carrier auditing the claim looks for.

North Dakota Medicaid states that image-capture-only radiographs obtained through teledentistry cannot be repeated in the office. If the patient later comes in, check what was already captured before retaking it.

What to get right in your PMS

The teledentistry line is a procedure code that has to reach the claim without a tooth number.

1. Set up D9995 and D9996 as separate procedures with a real fee that reflects what the technology and workflow cost the practice. Even when a plan bundles it, the fee has to be on the claim to be adjudicated.
2. Leave the tooth fields empty. The ADA marks area of the oral cavity, tooth system, tooth numbers, and tooth surface as not used on the teledentistry line. Templates that force a tooth entry will reject the claim.
3. Find where your software sets Item 38. POS is claim-level on dental claims, so in most systems it is a claim property rather than a procedure attribute.
4. Confirm Item 56 shows the practice address, not where the patient was.

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