Bulletin 201104 — New Temporary Fee Codes for Hospital-Based Dentists
Changes to the Schedule of Dental Benefits in response to COVID-19 outbreak effective November 7, 2020
To: Hospital-Based Dentists
Category: Dentist Services
Written by: Health Services Branch, Ontario Health Insurance Plan Division
Date issued: November 7, 2020
In support of the government’s efforts to limit the spread of COVID-19 in Ontario, the Minister of Health has made an Order under the authority of subsection 45(2.1) of the Health Insurance Act to temporarily list as insured services the provision of consultations, follow-up assessments, and visits to admitted bed patients, to insured persons when provided by telephone or video.
Hospital-based dentists will also be eligible for payment of premiums for temporary virtual care services that are after hour or weekend/holiday consultations, or consultation or visit to a patient in an intensive care facility (e.g., Intensive Care Unite (ICU) or Critical Care Unit (CCU).
These codes come into effect November 7, 2020.
Please Note: While payment for the provision of services associated with these temporary codes is effective November 7, 2020, system changes will be implemented over the coming weeks to process payment. As a result, the ministry requests that hospital-based dentists wait to submit claims for these codes until further notice. Further information regarding each of these changes will be forthcoming.
Temporary fee codes
Services by telephone or video
| Fee code | Description | Doctor of Dental Surgery (D.D.S.) | Spec |
|---|---|---|---|
| T655 | Consultation | $52.79 | $63.31 |
| T656 | Follow-up assessments within 12 months of initial consultation same diagnosis | $42.88 | $49.00 |
| T657 | Visit, admitted bed patient | $28.67 | $35.77 |
| T814 | Premium for a consultation or visit between 5:00 p.m. and midnight, or on a Saturday, Sunday or holiday | 30% of amt payable | 30% of amt payable |
| T815 | Premium for any consultation or visit to a patient in an intensive care facility (e.g., ICU or CCU) | 30% of amt payable | 30% of amt payable |
| T816 | Premium for a consultation or visit between midnight and 7:00 a.m. | 50% of amt payable | 50% of amt payable |
Notes:
- Despite any requirement in the Schedule of Dental Benefits or Regulation 552 under the Health Insurance Act that a direct physical encounter occur between the dental surgeon and the patient, the services described above as T655, T656, T657, T814, T815 and T816 are insured when the following conditions are met:
- The service is personally rendered by the dental surgeon.
- Other than a direct physical encounter, all the conditions for the appropriate consultation, assessment or visit as described in the Schedule of Dental Benefits have been met.
- T655 and T656 require the dental surgeon to be located in a public hospital graded under Regulation 964 of the Public Hospitals Act as Group A, B, C or D when the service is rendered; the patient may be at the location of their choice.
- T657 requires the patient to be an admitted hospital bed patient.
- T655 is limited to one consultation per year, per patient, by any one dentist, except where the same patient is referred to the same consultant a second time within the year with a clearly defined, unrelated diagnosis, where an additional consultation is then payable.
- T656 and T657 are limited to one service per patient, per day by any one dentist.
- Should an in-person encounter be required to complete the service, the in-person encounter is included as part of the Service by Telephone or Video (T655, T656 or T657) and is not separately payable.
- T655, T656 or T657 include the provision of a new prescription or prescription renewal if rendered.
- Dental surgeons are eligible for applicable premiums listed in the table above related to the provision of the temporary virtual care services (T655, T656, T657).
- The services must be documented on the patient’s medical record (including the start and stop times) or the service is not eligible for payment.
Commentary:
- See Part 1 Preamble of the Schedule of Dental Benefits for further requirements for billing of services.
- T656 is payable for telephone or video follow-up assessments of either an in-person, telephone or video consultation.
- T655, T656, T657 should follow the COVID-19: Guidance for the Use of Teledentistry from the Royal College of Dental Surgeons of Ontario (RCDSO).]
Keywords/tags
COVID-19; dental; virtual care; T655; T656; T657; T814; T815; T816
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Frequently asked questions
What changes are being made to the Schedule of Dental Benefits?
New temporary fee codes are being introduced to insure telephone or video consultations, follow-up assessments and visits to an admitted hospital bed patient by dental surgeons (subsequently referred to as “dentists”). These services would be a substitution for in-person care that would have otherwise been insured under Ontario Health Insurance Plan (OHIP).
When are these codes effective?
November 7, 2020.
While payment for the provision of services associated with these temporary codes is effective November 7, 2020, system changes will be implemented over the coming weeks to process payment. As a result, the ministry requests that hospital-based dentists wait to submit claims for these codes until further notice. Further information regarding each of these changes will be forthcoming.
Is there specific technology that needs to be used to bill these codes?
There are no specific technologies required. The provision of virtual services should follow the COVID-19: Guidance for the Use of Teledentistry from the Royal College of Dental Surgeons of Ontario (RCDSO).
Can I be paid for these services for non-COVID-19 patients?
Yes, these temporary services are not limited to patients who present with COVID-19.
Are the temporary fee codes payable for simply rescheduling a patient’s appointment?
No, these codes are not payable for calling or rescheduling appointments.
Are the temporary fee codes available for use by all hospital-based dentists?
Yes. The temporary fee codes provide a mechanism for hospital-based dentists to be paid an amount for telephone or video services that is equal to the amount that would be claimed for an equivalent in-person service.
Are diagnostic codes needed to bill the temporary fee codes?
Yes, diagnostic codes are required for all temporary fee codes.
Are the temporary fee codes different from the Ontario Virtual Care Program? How should providers receive compensation for their services?
The new temporary fee codes apply to all hospital-based dentists who are providing consultations, follow-up assessments, visits by telephone or video to patients eligible for OHIP insured services. Consultations (T655) and follow-up assessments (T656) require the dentist to be located in a public hospital graded under Regulation 964 of the Public Hospitals Act as Group A, B, C or D when the service is rendered; however, the patient may be at the location of their choice. For visits to an admitted bed patient (T657) the dentist may render the service from the location of their choice. Patient eligibility for insured services would be consistent with requirements in the Schedule of Dental Benefits.
Practitioners who are currently eligible and registered to use the Ontario Virtual Care Program (OVCP) using an approved OTN video solution can continue to provide services as usual as set out in the program requirements if they choose. Virtual care services covered by the OVCP are not insured under the Health Insurance Act. Although the program leverages the existing OHIP claims system for virtual care claims, they are processed separately from OHIP claims.
Practitioners can only receive compensation for services provided through one of these options, not both.
Will dentists be permitted to receive premiums associated with the temporary fee codes?
Yes, dentists are eligible for payment related to premiums for after hour consultations, or consultation or visit to a patient in an intensive care facility (e.g., ICU or CCU), related to the provision of the temporary virtual care services.
Why is the ministry only allowing dentists to bill OHIP for a consultation, follow-up assessment and visit? What about other fee codes?
OHIP insures certain dental services that are performed in an acute care hospital by a dentist on staff and when hospitalization is medically necessary to perform the dental service, either because it is a complex surgery or a patient’s other medical conditions require that they be hospitalized when the dental service is provided.
By enabling payment to hospital-based dentists for certain virtual care services, the ministry aims to respond to a potential resurgence of COVID-19 cases by reducing the need for in-person visits to hospitals and ensuring physical distancing can be maintained.
Does OHIP cover conversations with patients by e-mail or other methods of communication, when dentists provide the same level of advice and service as they would have by other virtual means?
The new temporary codes only reimburse dentists for services rendered by telephone or video.
With the temporary extension on expired health cards, what should we be doing with regard to billings for these patients? Will the MOH allow them to be submitted normally, or will they need to be logged and submitted at a later date?
In response to COVID-19, most expired and expiring health cards remain valid and can continue to be used for accessing insured and publicly-funded health services until further notice.
Providers are encouraged to continue to validate health cards at each point of service using ministry health card validation mechanisms to ensure the health card remains valid.
If the expired cards remain valid, dentists should submit their billings for those health card numbers using the typical claims submission process. The ministry has also suspended the deadline for the mandatory conversion of the red and white health cards at this time. As such, red and white health cards that remain valid and belong to the person presenting it may be also be accepted for insured and publicly-funded health services. Again, providers are encouraged to validate the card at each visit to ensure it remains valid for billing purposes.
If a health card does not pass validation, it cannot be accepted for insured health services and health care providers are encouraged to ask the card holder to attend ServiceOntario to update their health card registration/renew their card.
Please note that if an individual with an invalid card is billed directly for insured health services and pays out of pocket, health care providers should reimburse the individual the full amount paid if the individual is later able to prove they were eligible for OHIP coverage at the time of service by providing their valid health number and version code to the provider.
How should we bill for patients who have invalid health cards?
If a health card does not pass validation, it cannot be accepted for insured health services. Health care providers are encouraged to ask the card holder to attend ServiceOntario to update their health card registration/renew their card and provide the valid health card number and version code to the provider for billing purposes.
Please note that if an individual with an invalid card is billed directly for insured health services and pays out of pocket, health care providers should reimburse the individual the full amount paid if the individual is later able to prove they were eligible for OHIP coverage at the time of service by providing their valid health number and version code to the provider.