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Special Health Care Needs Benefit: Additional benefits when your patient needs them
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For 6.5 million people in the U.S. with intellectual or developmental disabilities, oral health care can be inaccessible or overwhelming. |
What is included in this benefit?
• Additional dental examinations and/or consultations that can be beneficial prior to treatment to help patients learn what to expect and what is needed for a successful dental appointment.
• Up to four total dental cleanings in a benefit year.
• Treatment delivery modifications (including anesthesia) necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, or other barriers to treatment.
Benefit Verification
Before rendering services, please check the member’s eligibility on our online dentist portal to verify coverage of our enhanced special needs benefit and other necessary procedures.
Simply add D9997 to an eligible member’s initial claim to trigger the enhanced benefit. Subsequent submissions of D9997 should only occur when necessary, as defined in the ADA’s current CDT definition for this code.
Training Opportunity
With support from the Delta Dental Foundation, Penn Dental Medicine has established a free continuing education course aimed at building awareness of the barriers to equitable oral health care for individuals with disabilities and developing competency to provide oral health care to this vulnerable population.
View Course
*Does not apply to Flagship, Fixed Copay PPO, or DeltaCare® USA.
How do I learn more?
- Judy Grancio: 973-285-4035 (973, 862, 201, 551, and 908)
- Mary Heinis: 862-268-3455 (609, 732, 856, 848, and 640)
