We continue to monitor American Dental Association guidelines, and local, state and federal guidance related to COVID-19. We also want to help you provide care to patients during this public health crisis. That’s why, effective March 21, 2020, Horizon NJ Health expanded benefits to include consultation through teledentistry.

When providing teledentistry services, use the following codes:

• D0191 – Assessment of a patient; use for the initial phone call. This is allowed once per date of service. Reimbursement for this code is $15./li>
• D9995 – Teledentistry – Synchronous; real-time encounter; use in conjunction with D0191 when the provider is unable to address the member’s needs during the initial phone call and when the provider and member have remote audio-visual access.
• Allowed once per date of service.
• When using D9995, the acceptable audio-visual platforms are FaceTime, Skype and Zoom. Facebook Live, Switch and Tik-Tok are not HIPPA compliant.
• Reimbursement for this code is $15.

You must document the phone call or video conference in the member’s chart/record and should request consent to assist with the member’s concern.

Treating your patients’ urgent care needs.

During office closures, in-network providers are required to have an answering machine or forwarding service in place. Calls related to urgent care should be returned within four hours. When responding to a message, please contact the patient and provide appropriate recommendations (for example, schedule an office appointment, refer member to another provider and/or specialist, advise member on when to seek Emergency Room treatment, etc.). Document the member’s concern and your recommendation(s) in member’s chart/record.

As we continue to monitor the changes in the dental and health care system, you have our commitment to keep you informed.

If you have any questions, please call Customer Service at 1-855-878-5368.