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. Those records move 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 being gathered. That gap in time is the whole code.

Two consequences follow, and both change how you build the claim:

• 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. A visit is either synchronous or asynchronous, so D9995 and D9996 never appear together on the same encounter.

There is also no CDT code for the collection, the transmission, or the receipt of the records themselves. Those steps belong in the chart note. South Dakota Medicaid makes the same point from the payment side: transmission of materials is not separately reimbursable.

D9996 against the codes it gets confused with

Four codes end up in this conversation, and only two of them are about delivery mode at all.

The teledentistry pair, split on timing.

• D9995 is synchronous. Live, two-way audiovisual interaction, everyone working the case together in real time, the dentist able to see and discuss 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 those same images the next morning are billing two different codes.

The two codes that answer a different question entirely.

• D9310 is a consultation, a diagnostic opinion rendered by a dentist or physician other than the one who requested it. That is a statement about who, not about how the information traveled. Store-and-forward is a common way to run a consultation, so the two codes can sit on the same claim.
• D9430 is an office visit for observation during regular hours with no other services performed. It is the structural opposite of D9996. D9430 requires that nothing else was billable; D9996 requires that something else was. Neither one describes a remote encounter, and swapping D9430 in 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, you are in D9996 territory.
2. Did the dentist actually 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 such as D0220, D0230, or D0350. Those lines are the claim. D9996 rides with them.
4. Does the plan allow those specific codes by teledentistry? State programs in particular publish closed lists. Confirm before the records are captured, not after the denial.
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 runs on two clocks. Records get captured on a Tuesday at a nursing facility, the dentist opens them on Friday and completes the evaluation, and the claim still needs a date.

The ADA’s completion instruction for Item 24 on the teledentistry line is the date the procedures delivered 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.

Where this is genuinely unsettled is the dentist’s own evaluation. 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 necessary when a continuum of 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 stops short of a single rule for which date a later evaluation carries, so treat that as a per-payer question and get the answer before the first claim rather than after.

Two things are not ambiguous:

• 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. A teledentistry line dated away from everything else on the claim has nothing left to ride on.
• 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. A batch of captured records that sits unopened for weeks spends that window before anyone has looked at it.

Coverage and how carriers treat it

Teledentistry coverage is unusually fragmented, because it sits on top of state practice acts, state Medicaid policy, and individual plan design at the same time. Verify per payer and per state rather than carrying a single rule across the book.

The line often pays zero by design. Several carriers treat the teledentistry code as inclusive of the exam. Delta Dental of Minnesota states the fees for D9995 and D9996 are considered inclusive in overall patient management, and adds that they are not billable to the patient. Read that second half carefully before posting a balance. Other payers do 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 when delivered by teledentistry, mostly evaluations and radiographic images, and states that 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 publishes its own list, which as of its January 2026 manual runs to evaluation and assessment codes including D0120, D0140, D0145, D0170, D0171, D0190, and D0191. The lists do not match each other, which is exactly the point.

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. That matches the ADA’s own instruction that quantity on the line cannot exceed 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 splits it further, 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 contact with the consulting dentist by audio-only means with no visual component, and does not cover 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 make the mode of delivery obvious, because the claim line alone does not prove it happened.

• Which modality was used. The note should say the encounter was asynchronous and that 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. There is no CDT code for them, so the note is the only record that they happened and that the connection was secure.
• When each step happened. The capture date and the review date are usually different on an asynchronous encounter, 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 own findings. The evaluation, diagnosis, and treatment plan. That is the substance behind the payable line, and it is what a carrier auditing a teledentistry claim is looking for.

One thing to avoid duplicating: North Dakota Medicaid states that image-capture-only radiographs obtained through teledentistry cannot be repeated in the office. If the patient later comes in, look at what was already captured before reshooting it.

What to get right in your PMS

Open Dental, Dentrix, Eaglesoft, Curve, and Carestream all handle this the same way underneath, as a procedure code that has to reach the claim without a tooth number.

1. Set D9995 and D9996 up as separate procedures with a real fee. The fee should reflect 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 kick the claim.
3. Get the place of service onto the claim. POS is claim-level on dental claims, so in most systems it is a claim property rather than a procedure attribute. Find where your software sets Item 38 before the first teledentistry claim goes out.
4. Confirm Item 56 shows the practice address, not wherever the patient was sitting.
5. Build a per-payer note for eligible codes. Which evaluations and images each plan or state program allows by teledentistry is the detail that decides whether the claim pays. Keep it with the plan’s frequency notes so verification catches it.
6. Decide the write-off rule in advance. Bundled teledentistry lines keep coming back at zero. Put the posting rule in the collections notes.

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.