Understanding Dental Code D9995

When to Use D9995 dental code

The D9995 dental code is designated for teledentistry services delivered via synchronous, real-time audio and video communication between the dental provider and the patient. This code should be reported when a dentist or hygienist conducts a live, interactive consultation, examination, or follow-up with a patient who is not physically present in the office. Common scenarios include urgent care triage, post-operative evaluations, and consultations for patients with mobility or transportation challenges. It is important to note that D9995 is an adjunctive code—it should be billed in addition to the primary procedure code for the clinical service provided during the virtual encounter.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing D9995. Best practices include:

• Record the start and end time of the synchronous encounter.
• Document the technology used (e.g., HIPAA-compliant video platform).
• Note the reason for the teledentistry visit and the clinical findings.
• Include the CDT code(s) for the primary dental service rendered (e.g., evaluation, consultation, or triage).
• Obtain and record patient consent for teledentistry services.

Typical clinical scenarios for D9995 include:

• Evaluating a dental emergency, such as pain or swelling, to determine if an in-person visit is necessary.
• Post-operative follow-up after extractions or surgery, reducing unnecessary office visits.
• Remote consultations for patients in rural areas or those with limited mobility.

Insurance Billing Tips

Successfully billing D9995 requires attention to payer policies and thorough claim preparation. Here are actionable tips:

• Verify coverage for teledentistry with each patient’s insurance prior to the appointment. Not all payers reimburse for D9995, and some may have specific requirements.
• Submit D9995 as a separate line item on the claim, in addition to the primary CDT code (such as limited oral evaluation).
• Attach supporting documentation—such as encounter notes and patient consent—to expedite claim processing and reduce denials.
• If a claim is denied, review the EOB for denial reasons and be prepared to submit a claim appeal with additional documentation if necessary.
• Keep up-to-date with payer changes, as teledentistry policies are evolving rapidly post-pandemic.

Example Case for D9995

Consider a patient who recently underwent a surgical extraction and is experiencing mild discomfort. The dental office schedules a synchronous video call to assess healing and address concerns. During the call, the dentist visually examines the surgical site, reassures the patient, and provides care instructions. The office bills D9995 for the teledentistry encounter and D0170 for the post-operative evaluation. Documentation includes the time of the call, technology used, patient consent, and clinical notes. This approach improves patient satisfaction, reduces unnecessary in-person visits, and ensures proper reimbursement for virtual care.