The dental insurance landscape continues evolving, with several trends directly impacting practice revenue and administrative workflows. Understanding these changes helps practitioners adapt billing strategies and patient communications accordingly.

Annual Maximums Finally Rising

After decades of stagnant $1,000-1,500 annual maximums, major carriers including Delta Dental, Cigna, and Aetna are introducing plans with $2,000-3,000 limits. While not universal, these enhanced plans are gaining employer adoption.

The change reflects recognition that historical maximums, unchanged since the 1970s, would exceed $8,000 today if adjusted for dental inflation. Practitioners can expect gradual improvement in coverage adequacy over the coming years.

Teledentistry Reimbursement

CDT codes D9995 (synchronous teledentistry) and D9996 (asynchronous teledentistry) now receive reimbursement from most major carriers, though rates and covered services vary significantly. Some plans reimburse virtual consultations at 100% of in-office rates; others apply substantial reductions.

Documentation requirements for teledentistry claims are more stringent than in-person visits. Maintain detailed records of technology used, patient consent, and clinical justification for virtual care delivery.

Medical-Dental Integration

Cross-billing for periodontal treatment in diabetic patients, oral appliance therapy for sleep apnea, and preventive care for cardiac patients continues expanding. More plans now accept medical claims for oral conditions with documented systemic connections.

Practices pursuing medical billing should invest in proper training. Medical coding differs substantially from dental coding, and improper claims can trigger audits and repayment demands.

Prior Authorization Trends

Prior authorization requirements are expanding to include procedures previously exempt, including some crown and implant cases. Build additional lead time into treatment planning to accommodate authorization timelines.

Some states are implementing prior authorization reform legislation limiting insurer response times and requiring clinical justification for denials. Stay informed about regulations in your state that may improve the authorization process.