Bulletin 210202 — Implementation of Temporary Fee Codes for Hospital-Based Dentists

Hospital-based dentists can begin to submit claims for payment of temporary COVID-19 fee codes on February 1, 2021

To: Hospital-Based Dentists
Category: Dentist Services
Published by: Health Services Branch, Ontario Health Insurance Plan Division
Date Issued: February 4, 2021

Effective February 1, 2021, system changes have been implemented in association with the Temporary Fee Schedule Codes listed below. Hospital-based dentists can now submit claims for payment for these services.

In support of the government’s efforts to stop the spread of COVID-19 in Ontario, the Minister of Health 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 certain services (consultations, follow-up assessments, and visits to admitted bed patients) when provided to insured persons by telephone or video.

Hospital-based dentists will also be eligible for payment of premiums related to these temporary virtual care services for after hour or weekend/holiday consultations, or consultations or visits to a patient in an intensive care facility (e.g., ICU or CCU).

Eligibility for payment of Temporary Fee Schedule Codes T655, T656, T657, T814, T815 and T816 was effective November 7, 2020. Claims for payment for services provided on or after November 7, 2020 can now be submitted.

Temporary codes

Services by telephone or video

Notes:

1. 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:
   1. The service is personally rendered by the dental surgeon.
   2. 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.
2. 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.
3. T657 requires the patient to be an admitted hospital bed patient.
4. 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.
5. T656 and T657 are limited to one service per patient, per day by any one dentist.
6. 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.
7. T655, T656 or T657 include the provision of a new prescription or prescription renewal if rendered.
8. 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).
9. 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:

1. See Part 1 Preamble of the Schedule of Dental Benefits for further requirements for billing of services.
2. T656 is payable for telephone or video follow-up assessments of either an in-person, telephone or video consultation.
3. 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;

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.