COVID-19 Testing: Maine CDC Updated Guidance
Maine Department of Health & Human Services sent this bulletin at 05/27/2020 04:55 PM EDT
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COVID-19 Testing: Maine CDC Updated Guidance
In order to receive MaineCare reimbursement for COVID-19 testing services, MaineCare providers are expected to follow Maine CDC guidance regarding the prioritization of testing individuals for COVID-19, as released through the CDC’s Health Alert Network System. The CDC currently recommends that COVID-19 tests should be prioritized for individuals who are showing at least one symptom of COVID-19, or for asymptomatic individuals who may be at risk for transmitting COVID-19 to others, such as health care workers and first responders who have been exposed to a confirmed COVID-19 case, or asymptomatic individuals who have had close contact with confirmed COVID-19 cases in settings such as a congregate care facility. This guidance applies to COVID-19 testing for all MaineCare members, including those who are covered through the Emergency MaineCare benefit, as well those who are covered under the new testing benefit for uninsured individuals. Rulemaking on this requirement will be forthcoming.
Please be sure to subscribe to receive updates through the CDC’s Health Alert Network System, as testing and other guidance may change.
Telehealth and Dental Services
Effective March 1, 2020, the following codes will be added as MaineCare-covered services in order to enable payment to dental providers for triage and screening services performed via telehealth:
- D0190 – Patient Screening. This is a screening, including state or federally mandated screenings, to determine an individual’s need to be seen by a dentist for diagnosis.
- D0191 – Patient Assessment. This is a limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury, and the potential need for referral for diagnosis and treatment.
These codes can be billed on their own, or with the following two codes that will be added effective March 1, 2020. The following codes are used to indicate that the other service on the claim was performed via telehealth. Per guidance from the State of Maine Board of Dental Practice, MaineCare providers should only use these codes in conjunction with codes related to triage and screening.
- D9995 tele-dentistry – Synchronous; real-time encounter. Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.
- D9996 tele-dentistry – Asynchronous; information stored and forwarded to dentist for subsequent review.
Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.
D9995 and D9996 should not be billed on their own as they are used to indicate how the services were delivered and will always pay at zero. The codes should be appended to a claim that includes the triage and/or screening codes to note the modality of service (telehealth). Providers should submit a claim with the reimbursable triage or screening code on one service line and then the D9995/D9996 on the other service line to designate the service was performed via telehealth. Please see the updated ADA guidance for more information on these D-codes.
Providers may also provide triage and screening services through use of D9995/D9996 in conjunction with existing codes D0140 limited oral evaluation – problem focused; D0170 re-evaluation – limited, problem focused (established patient; not post-operative visit); or D0171 re-evaluation – post-operative office visit.
Please see the following scenarios as examples of when a provider must also indicate the D9995 or D9996 codes to indicate the triage and screening related services were performed via telehealth.
- Scenario 1: Patient contact with dentist who provides the consultation using audio only.
- Coding: D0190 (screening)
- Scenario 2: Patient contact with dentist who provides the problem-focused evaluation using audio/visual.
- Coding: D0140 or D0170 or D0171
Please remember that all providers are still required to bill in accordance with the guidance and regulations outlined by the State of Maine Board of Dental Practice.