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

   1. (a) Live video, a two-way interaction between a member and dentist using audiovisual technology;
   2. (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;
   3. (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
   4. (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. (2) 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;

   1. (a) The member’s chart documentation must reflect notification of the right to interactive communication with the distant site dentist; and
   2. (b) A member may request to have real time communication with the distant dentist at the time of the visit or within 30 days of the original visit.
3. (3) Providers must be licensed to practice dentistry and enrolled as a Medicaid provider as required by OAR 410-120-1260.
4. (4) All Dental Services rules, criteria, limits, and billing requirements apply to teledentistry services in the same manner as other services.

5. (5) Providers billing for covered teledentistry services must follow all telehealth requirements in OAR 410-120-1990, which include:

   1. (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;
   2. (b) Obtaining and maintaining technology used in the telehealth communication that is compliant with privacy and security standards;
   3. (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
   4. (d) Maintaining clinical and financial documentation related to telehealth services as required in OAR 410-120-1360 and OAR 410-120-1990.

6. (6) General Billing Requirements:

   1. (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;
   2. (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; and
   3. (c) 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.

7. (7) Teledentistry billing requirements:

   1. (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;
   2. (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;
   3. (c) The provider must report the teledentistry event using the teledentistry billing codes for synchronous (D9995) or asynchronous (D9996), as appropriate; and
   4. (d) D9995 and D9996 are not eligible for separate reimbursement.

Statutory/Other Authority

ORS 679.543 & ORS 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 93-2025, amend filed 12/22/2025, effective 01/01/2026
DMAP 139-2024, amend filed 12/06/2024, effective 01/01/2025
DMAP 66-2024, minor correction filed 02/21/2024, effective 02/21/2024
DMAP 50-2021, amend filed 12/24/2021, effective 01/01/2022
DMAP 61-2020, amend filed 12/11/2020, effective 01/01/2021
DMAP 119-2018, adopt filed 12/26/2018, effective 01/01/2019