Or. Admin. Code § 410-123-1265

Current through Register Vol. 64, No. 1, January 1, 2025

Section 410-123-1265 - Teledentistry

(1) Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to:

(a) Live video, a two-way interaction between a member and dentist using audiovisual technology;

(b) Store and forward, an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the member being present in real time;

(c) Remote member monitoring, where personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care; and

(d) Mobile communication devices such as cell phones, tablet computers, or personal digital assistants that may support mobile dentistry, health care, public health practices, and education.

(2) All Dental Services rules, criteria, limits, and billing requirements apply to teledentisry services in the same manner as other services.

(3) Billing Provider Requirements, as referenced in OAR 410-120-1990:

(a) Dentists providing Medicaid services must be licensed to practice dentistry within the State of Oregon or within the contiguous area of Oregon and must be enrolled as provider with the Authority;

(b) Providers billing for covered teledentistry/telehealth services are responsible for the following:

(A) Complying with Health Insurance Portability and Accountability Act (HIPAA) and Oregon Health Authority (OHA) Confidentiality and Privacy Rules and security protections for the patient in connection with the telemedicine communication and related records (Refer to OAR 410-120-1990);

(B) Obtaining and maintaining technology used in the telehealth communication that is compliant with privacy and security standards in HIPAA and Department Privacy and Confidentiality Rules described in subsection (1) of this rule;

(C) Ensuring policies and procedures are in place to prevent a breach in privacy or exposure of member health information or records (whether oral or recorded in any form or medium) to unauthorized individuals; and

(D) Maintaining clinical and financial documentation related to telehealth services as required in OAR 410-120-1360 and OAR 410-120-1990.

(c) A member receiving services through teledentistry must be notified of the right to receive interactive communication with the distant dentist and must receive an interactive communication with the distant dentist upon request;

(d) The member's chart documentation must reflect notification of the right to interactive communication with the distant site dentist; and

(e) A member may request to have real time communication with the distant dentist at the time of the visit or within thirty (30) days of the original visit.

(4) General Billing Requirements:

(a) Unless authorized in OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered;

(b) The dentist may bill for teledentistry on the same type of claim form as other types of procedures unless in conflict with the Dental Services rules;

(c) All Dental Services rules, criteria, and limits apply to teledentistry services in the same manner as other services; and

(d) As stated in ORS 679.543 and this rule, payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

(5) Teledentistry billing requirements:

(a) The dentist who completes diagnosis and treatment planning and the oral evaluation also documents these services using the traditional Current Dental Terminology (CDT) codes. This provider also reports the teledentistry event using D9995 or D9996 as appropriate (See the Dental Billing Instructions for details at: www.oregon.gov/oha/HSD/OHP/Pages/Policy-Dental.aspx); and

(b) The originating site may bill a CDT code only if a separately identifiable service is performed within the scope of practice of the practitioner providing the service. The service must meet all criteria of the CDT code billed.

Or. Admin. Code § 410-123-1265

DMAP 119-2018, adopt filed 12/26/2018, effective 1/1/2019; DMAP 61-2020, amend filed 12/11/2020, effective 1/1/2021; DMAP 50-2021, amend filed 12/24/2021, effective 1/1/2022; DMAP 66-2024, minor correction filed 02/21/2024, effective 2/21/2024; DMAP 139-2024, amend filed 12/06/2024, effective 1/1/2025

Statutory/Other Authority: ORS 679.543 & ORS 414.065

Statutes/Other Implemented: ORS 414.065