What is Tele-Dentistry? Its Benefits, Essential and Relevant Codes

Dental virtual care was once thought to be an unimaginable healthcare treatment format. It is, in fact, now a central pillar of modern patient acquisition, case triage, and practice expansion. Although telehealth has gained rapid adoption in general medicine, dental practices are often found wondering about the efficiency of this format of dental care for their patients.

Tele-dentistry in modern times is not here to replace dentists once and for all. But rather, it acts as an avenue through which one can have better access to dental care. This virtual dentistry can be utilized as a post-operative visit, for a case of toothache evaluation, or even for coordination among satellite sites. Tele-dentistry connects patients with clinical attention where they need it most.

However, operational challenges in the form of denied insurance claims, incorrect procedure codes, and new parity guidelines keep surfacing. A deeper knowledge of clinical procedures, regulatory requirements, and dental billing codes is mandatory to capture all possible payments.

Defining Tele-Dentistry

The essence of tele-dentistry involves the use of technology in the form of virtual dental consultation by the dentist to give advice to a patient. This is executed via live video or secure image sharing for a later diagnosis/treatment. This makes healthcare far more accessible for the patients, including ones who had an otherwise inaccessible dental care. It has four models of execution, as:

Live Video (Synchronous):

This entails the real-time interaction between a patient and provider just like an urgent care video visit that can be arranged via the app of the patient’s primary healthcare practitioner.

Store-And-Forward (Asynchronous)

Pictures, X-rays, and scans are taken by a hygienist in a separate satellite location (remote location), and sent to the dentist to assess the patient’s condition at their convenience.

Remote Patient Monitoring

This involves ongoing monitoring of a patient’s treatment process or recovery progress, and is most useful for orthodontic patients.

Mobile Health (mHealth)

While it is not deemed valuable as the direct virtual dental care, this form of cellular dental messaging known as mHealth is also available. It includes reminders, hygiene coaching, and educational information delivered to patients via apps or text messages.

We know that what can be done without much hassle is easy, and tele-dentistry has proven to be a far better approach where continued treatments or observations are concerned. It replaces the worrisome idea for a dental visit on the occasion of “should I be worried about this gum pain” with a virtual call for an assessment or a quick second opinion.

Telehealth Vs Tele-dentistry

Both these terms are often used interchangeably, but they hold their differences. Telehealth is the more general term, which includes any interaction between a healthcare professional and a patient via the internet. It could range from anything to a psychiatrist using video conferencing, to a nutritionist making a phone call.

Whereas, tele-dentistry is the sub-service of telehealth, dedicated to the virtual or the telecom dental services within the dental industry. They are singularly effective when dealing with the remote patient monitoring or the initial basis diagnosis or consultation.

This difference actually affects the practices at the claims desk. Drop a generic telehealth CPT code onto a dental claim instead of the right CDT add-on, and you can pretty much count on a denial. It’s a small distinction with a big consequence.

The Role of Tele-dentistry in Today’s Dental Healthcare Industry

Tele-dentistry has quietly graduated from “interesting pilot program” to something a lot of practices genuinely rely on. A few reasons it isn’t going anywhere:

Making Dental Care Accessible to Satellite/Remote Areas

This makes the dental services available for those who would not have had access any other way. Around 60 million Americans are located in a defined Dental Health Professional Shortage Area, according to HRSA (2024). One dental provider now has the ability to oversee treatment that is occurring at a satellite office. Even though they are not physically present during every step of the procedure, they can still guide and deliver first-degree dental treatments to the patients.

Reduces the On-Site Consultation Time

A short virtual session for an initial consultation saves a lot of time that would have otherwise been wasted for the dentist. It also decreases the chances of last-minute cancellations and emergency visits.

Follow-up Visits Are Best Handled Here

The orthodontic progress checks, healing reviews after a procedure, denture-fit questions, and second-opinion visits take a lot of on-site time. A lot of these cases can be handled way more efficiently over video instead.

Improves the Care Team Access

Dental hygienists at a satellite site can capture images and notes that the dentist reviews remotely, which is already how a lot of school-based and public health dental programs operate. While this would have only been handled by the on-site hygienist previously, expert opinions and evaluations are now also in the loop.

It’s Showing Up in Practice Data

The ADA’s Health Policy Institute has pointed to figures in the 14–18% range for practices using some form of remote review-type care, and that number keeps inching up as more payers come around to reimbursing it.

For billing teams, all of this growth translates into a rising volume of claims tied to a code set that’s still, relatively speaking, new, and one that a lot of front-office staff haven’t been fully trained on yet.

HIPAA & Regulatory Compliant Tele-dentistry

Any time you’re sending images, video, or chart notes over the internet, you’re moving protected health information, and that means HIPAA isn’t a box you check once and forget about. A platform that isn’t compliant can turn one convenient video visit into a real liability problem, and it can tank a claim before it even gets reviewed.

A tele-dentistry setup that actually holds up should include:

• A signed Business Associate Agreement (BAA) with whatever platform you’re using for video or image transfer
• End-to-end encryption on all patient communication channels and data storage sites; calls, messages, and stored files, on-site servers and cloud data
• Access-controlled storage so patient records aren’t just sitting in a shared folder somewhere
• Documented, encounter-specific consent, obtained and saved before the visit happens, not after
• Licensure that matches where the patient actually is, not where your office is
• An audit trail logging who touched patient data and when

HIPAA is just the floor, though. Layered on top of it:

• State dental board rules, which vary more than you’d think, some states want an established in-person relationship before a virtual visit counts; others don’t.
• ADA policy guidance, which shapes what “best practice” documentation and consent look like (ADA, 2023).
• Payer-specific telehealth policies, because Medicaid programs and commercial dental plans each write their own rules on coverage and place-of-service reporting.

This is exactly the kind of layered compliance puzzle that pushes a lot of practices toward outsourcing the administrative side rather than trying to keep every rule straight in-house.

Tele-dentistry Coding: Essential and Connected Codes

This is where most of the actual denials happen, not because the care wasn’t legitimate, but because the claim wasn’t built correctly. Back in 2017–2018, the ADA introduced two CDT codes made specifically for tele-dentistry, and they’re still the backbone of how these visits get billed today.

The Core Codes

There are only two codes that are used directly to state if the satellite consultation was via live video or shared for later review.

• D9995: Live Video; Synchronous:

It is considered as the virtual Real-Time Encounter. This is the correct code for the case where there is a live interaction between the dentist and the patient through video.

• D9996: Store-and-Forward; Asynchronous:

Stored/Forwarded information to the dentist for review. It is the appropriate code where the images/data have been collected and transmitted to the dentist for review.

Tele-Dentistry Code Rules

Applying the codes have their own set of regulations which must be complied with:

• Both codes cannot function alone

The codes, D9995 and D9996, are modifiers that will come along with the procedure code for the visit, such as D0140 (Limited Oral Evaluation), D0170, or D0171.

• Pick only one code each day; not two codes

It has to be either D9995 or D9996 depending on whether the visit was a live call or a store-and-forward. Using both in one claim is doomed for denial.

• Place of Service (POS) code 02 

This code needs to be on the claim to mark it as a telecom dental encounter rather than an in-office visit.

• Clinical Documentation

The documentation must include all aspects of the encounter; scheduled date, start and end time, platform used, clinical identifications, and clinical support for the need of a virtual visit.

Commonly paired procedure codes

None of this is complicated once you’ve seen it a few times. But get the pairing wrong even once, and you’re looking at a rejected claim, an appeal, and staff hours that could’ve gone toward something else entirely.

Tele-dentistry Insurance Application: Coverage Plans, Usage, and Payer Requirements

Coverage has gotten better over the past few years, but “better” doesn’t mean consistency. The same exact encounter can sail through with one payer and get flatly denied by another, which is frustrating, but it’s the reality that billing teams have to plan around.

A few things worth knowing:

• Medicaid coverage varies by state. Plenty of state Medicaid programs now reimburse D9995 and D9996, but the fine print differs, some cap reimbursement at once per date of service, others won’t count an asynchronous-only visit as a full dental encounter for FQHC or Rural Health Clinic reporting.
• Commercial payers are a mixed bag. Some will pay a modest add-on fee for the tele-dentistry code; others just fold it into the evaluation code and pay nothing extra for D9995 or D9996 specifically.
• Employer and PPO plans are catching up, increasingly listing tele-dentistry as a covered benefit, especially for urgent triage and post-op follow-ups, though pre-authorization and network rules still apply in a lot of cases.
• Verification is Compulsory. With this much variability, checking tele-dentistry benefits before the visit, not after the claim bounces back, is really the only way to avoid surprises.

A quick checklist before billing a tele-dentistry claim:

• Does this payer actually reimburse D9995/D9996? (Not all do.)
• Is POS 02 accepted on their dental claims?
• Does the plan require prior authorization for virtual visits?
• Has the patient already used up a similar benefit this plan year?
• Is consent and encounter documentation saved and ready, in case of an audit?

Challenges & Limitations of Tele-Dentistry Billing

Tele-dentistry solves real problems, but let’s not pretend the billing side is frictionless, because it isn’t.

• Payer rules are all over the map. There’s no single national standard, so billing teams end up tracking coverage policy payer by payer, state by state.
• Miscoding is the number-one denial cause. Billing D9995 or D9996 as a stand-alone line, without the underlying procedure code attached, is probably the single most avoidable mistake out there, and also the most common.
• Licensure gets messy. A dentist needs to be licensed in whatever state the patient is physically sitting in during the call, which complicates things for multi-state practices and mobile programs.
• The extra payment can be small. Even when a payer does reimburse the tele-dentistry add-on, the amount is often modest enough that practices start wondering if the paperwork is worth it, unless the billing process is genuinely tight.
• Systems don’t always catch the gaps. Not every practice management platform flags a missing consent form or an incorrect POS code before the claim goes out the door.
• Patients face their own barriers. Reliable broadband and comfort with video tech still limit how far tele-dentistry reaches into exactly the rural and underserved communities it’s supposed to help.

None of this is a reason to skip tele-dentistry. It’s a reason to build a billing process, in-house or outsourced, that’s actually designed around these specific pain points instead of bolted onto a system built for routine chairside billing.

Professional Tele-Dentistry Billing Services for Your Dental Practice

Here’s the part practices don’t always want to hear: most in-house billing teams are excellent at coding fillings, crowns, and cleanings, and genuinely under-trained on the nuances of telehealth add-on codes, payer-specific POS requirements, and the patchwork of state Medicaid tele-dentistry rules. That gap is exactly where claims quietly get denied and revenue slips through unnoticed.

A billing partner that actually specializes in this brings:

• Payer-specific know-how on who reimburses D9995/D9996 and under what conditions
• Clean claims from the start, with the tele-dentistry code correctly paired to the procedure and POS code every single time
• Real-time eligibility checks, so the front desk knows what’s covered before the video call even starts
• Denial management built for tele-dentistry specifically, not just generic dental appeals
• Documentation and consent tracking that holds up if a payer ever comes asking for an audit
• Reporting that actually shows the numbers, how much revenue tele-dentistry is generating, and where it’s leaking

No matter whether your practice is just getting started in the virtual visits space or you already operate an established tele-dentistry service, having a specialist immersed in the domain means more approvals, quicker reimbursements, and much less time wasted on deciphering the details of payer guidelines.

Conclusion

Tele-dentistry is not a trend that is here to disappear anytime soon; it is a paradigm shift in the field of dentistry supported by billions of predicted market growth and continuously increasing list of payers who are ready to cover it. However, all of the aforementioned clinical benefits translate into revenues only with an adequate billing process in place: correct CDT coding, strict HIPAA compliance, payer verification, and audit-proof documentation.

Get those pieces lined up, and tele-dentistry becomes exactly what it’s supposed to be, real access for patients who need it, and a genuinely sustainable new revenue line for the practice that’s willing to bill it properly.

FAQs

1. Do we need separate consent forms for tele-dentistry visits?

Yes. most state dental boards and payers expect documented, visit-specific consent saved before you bill the encounter.

2. Can the tele-dentistry codes D9995 and D9996 be billed for the same patient on the same day?

No. As both of these codes identify different care formats, they can contradict one another if applied in the same claim. Choose the one which coordinates with the clinical documentation, whether synchronous or asynchronous, then submit the claim. Applying both in one is a direct path for claim denial.

3. Does Medicaid reimburse my tele-dentistry claims in Illinois?

Yes, it does. While the Medicaid Illinois division covers the tele-dentistry evaluations, it is highly dependent on the state wise Medicaid tele-dentistry regulations. Many programs now cover D9995/D9996, but the coverage limitations differ, thus you must verify before you submit the claims.

4. What are some of the most common reasons that tele-dentistry claims get denied?

Coding errors such as billing D9995 or D9996 by itself, unclear or missing documentation, and regulatory compliance are some of the prominent shortcomings in a claim which result in their denials.

5. Does our dentist need to be licensed in the patient’s state to bill for a virtual visit?

Generally, yes. Licensure follows wherever the patient physically is at the time, not where the practice is located.

6. Is outsourcing tele-dentistry billing actually worth it for a smaller practice?

For most, yes, a specialized partner tends to catch denials and payer quirks that in-house teams simply don’t have the bandwidth to track.