Emergency coverage - dental phone triage

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Apple Health (Medicaid) Provider Alert

Effective immediately, in response to the circumstances surrounding COVID-19, the Health Care Authority (HCA) will cover CDT code D9992 (care coordination) to allow dentists to provide phone triage of clients with emergency dental needs. HCA will cover CDT code D9992 until April 24, 2020, date of service.

The rate for CDT code D9992 is $15, per client, per day. This is not a teledentistry procedure code and is not billable with teledentistry procedure codes. This code is intended to be separate from teledentistry. Do not use CDT D9992 for routine phone conversations used to conduct normal business operations in the dental office, such as scheduling appointments.

Providers must keep supporting documentation in the client’s file, including the client’s phone number, reason for triage, progress note that includes patient’s reported clinical information (e.g., pain level, swelling, bleeding, trauma), outcome, and name of provider.

Federally qualified health centers (FQHC), rural health centers (RHC), Indian Health Services (IHS) facilities, tribal clinics and tribal FQHCs

Phone triage performed by a dentist for a client with emergency dental needs qualifies for the dental encounter rate. If the phone triage service results in an in-person visit on the same day, by the same dentist, HCA pays only one encounter rate payment.