Temporary OHIP insured virtual care services for hospital-based dentists are being extended

To: Hospital Based Dentists
Category: Dentist Services
Written by: Provider Services Branch, Physician and Provider Services Division
Date issued: March 29, 2023

Further to INFOBulletin 220908, the Ministry of Health has extended the use of existing temporary provision of consultations, follow-up assessments, and visits to admitted bed patients, as insured services under Ontario Health Insurance Plan (OHIP) when provided by telephone or video until further notice. This will support patients’ continued access to essential dental care.

Hospital-based dentists will continue to 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 unit (ICU) or Critical Care Unit (CCU) as listed below:

Services by telephone or video

Fee code Description Doctor of Dental Surgery (D.D.S.) Specialist
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 amount payable 30% of amount payable
T815 Premium for any consultation or visit to a patient in an intensive care facility (example: ICU or CCU) 30% of amount payable 30% of amount payable
T816 Premium for a consultation or visit between midnight and 7:00 a.m. 50% of amount payable 50% of amount payable

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 by OHIP 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 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 only 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

dental; virtual care; T655; T656; T657; T814; T815; T816

Contact information

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