FAQs
Medicare Benefit Schedule (MBS)
Category 7: Cleft and Craniofacial Services
The following Frequently Asked Questions have been compiled by ozED to synthesize the information available to both patients and providers regarding the Medicare Benefit Schedule (MBS) Category 7: Cleft and Craniofacial Services.
All answers are supported by either:
- relevant links back to official Medicare and Services Australia websites and documents
- updates from Cleft and Craniofacial Team, MBS Policy & Specialist Programs Branch, Medicare Benefits & Digital Health Division, Australian Department of Health & Aged Care.
Is the Cleft Lip and Cleft Palate Scheme still available?
As part of the changes implemented in March 2024, the Cleft Lip and Cleft Palate Scheme has been reinvigorated and is now known under the Medicare Benefit Schedule (MBS) Category 7: Cleft and Craniofacial Services. To avoid confusion when speaking to Medicare or Providers about services available we recommend that you refer to “Category 7: Cleft and Craniofacial Services”.
Refer: change in MBS Books:
- November 2023 – formally known as: CATEGORY 7: CLEFT LIP AND CLEFT PALATE SERVICES
- March 2024 – updated to: CATEGORY 7: CLEFT AND CRANIOFACIAL SERVICES
Do people with Ectodermal Dysplasia get any dental cover with Medicare?
Yes, Ectodermal Dysplasia is an eligible condition under MBS Category 7: Cleft and Craniofacial Services
Refer: MBS Online: CN.3.1 Patient Eligibility
Attachment: PDF Version – Information Sheet – Cleft and Craniofacial Services Patient eligibility – Effective 1 March 2024
Do I need to register to be covered under MBS Category 7: Cleft and Craniofacial Services?
No, you do not need to register or get a special number to be able to claim services under MBS Category 7: Cleft and Craniofacial Services
With the removal of age restrictions [on 1 Nov 2023], registration became unnecessary. Eligibility has been opened to people of all ages with eligible conditions.
Refer: MBS Online: CN.3.1 Patient Eligibility
Attachment: PDF Version – Information Sheet – Cleft and Craniofacial Services Patient eligibility – Effective 1 March 2024
How will Medicare know that I am eligible if I do not need to register or have a card / registration number to show?
A medical or dental practitioner must notate ‘certified dental patient‘ on the patient’s account or include ‘certified dental patient’ in the text field when submitting a Medicare claim for benefits.
Refer: Services Australia: Cleft or Craniofacial Patient Certification
Are there any age restrictions on treatment?
No, there is no longer any age restriction on treatment following the amendments made on 1 November 2023.
Refer: MBS Online Factsheet: Expanding patient access to Cleft Dental Services
Attachment: PDF Version – Factsheet for Cleft Dental Services – Effective 1 November 2023
Note: If you were treated before 1 November 2023, you can only claim Medicare benefits if:
- you were under 28 years of age at the time of your treatment
- your treatment was to repair previous reconstructive surgery.
Refer: Services Australia: Cleft and craniofacial conditions
Note: we had queried the possibility of backdating the removal of age restriction so that people can claim for treatment completed prior to 1 November 2023, however this is not possible as “services delivered prior to 1 November 2023 are subject to the policy and legislation at the time of service and are therefore not eligible for retrospective Medicare benefit payments.”
What is covered / included in Category 7: Cleft and Craniofacial Services?
There are 44 MBS Item Numbers included in the Category 7: Cleft and Craniofacial Services schedule.
Medicare benefits are based on fees determined for each Schedule service. The fee is referred to in these notes as the “Schedule fee”. The fee for any item listed in the Schedule is that which is regarded as being reasonable on average for that service having regard to usual and reasonable variations in the time involved in performing the service on different occasions and to reasonable ranges of complexity and technical difficulty encountered.
There are presently two levels of Medicare benefit payable for cleft lip and cleft palate services:
- 75% of the Schedule fee: for professional services rendered to a patient as part of an episode of hospital treatment (other than public patients).
- 85% of the Schedule fee, or the Schedule fee less $98.70 (indexed annually), whichever is the greater, for all other professional services.
Refer: MBS Online: CN.0.1 Schedule Fees and Medicare Benefits
The table below outlines all 44 MBS Item numbers included in Category 7: Cleft and Craniofacial Services (note the table has been extracted from the XML Data MBS-XML-20240701 Version 2 (XML 7959 KB): File released on 19 June 2024, effective 1 July 2024.
Refer: MBS Online: July 2024 Downloads
Refer: Create Publication | Medicare Benefits Schedule (health.gov.au) – enter item numbers to create MBS Book
Attachment: MBS Online Publication Items 75002-75854 Effective – 04 July 2024
| Item Num | Schedule Fee | Description | Benefit 75% | Benefit 85% | |
|---|---|---|---|---|---|
| 75002 | 97.4 | Initial professional attendance, in a single course of treatment (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies) | 73.05 | 82.8 | |
| 75005 | 49 | Subsequent professional attendance in a single course of treatment (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies) | 36.75 | 41.65 | |
| 75007 | 86.8 | Production of dental study models (other than a service associated with a service to which item 75002 or 75005 applies) prior to provision of a service to which: (a) item 75030, 75032, 75039, 75045 or 75051 apply; or (b) an item in Group T8 or Groups O3 to O9 apply; or (c) item 52321, 53212 or 75618 apply; or (d) any of items 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 apply; in a single treatment | 65.1 | 73.8 | |
| 75009 | 77.7 | Orthodontic radiography—orthopantomography (panoramic radiography), including any consultation on the same occasion | 58.3 | 66.05 | |
| 75012 | 123.1 | Orthodontic anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion | 92.35 | 104.65 | |
| 75015 | 169.2 | Radiographyanteroposterior and lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion | 126.9 | 143.85 | |
| 75023 | 52.9 | Intraoral radiography—single area, periapical or bitewing film | 39.7 | 45 | |
| 75024 | 683.65 | Pre-surgical infant maxillary arch repositioning including nasoalveolar moulding, supply of appliances and all adjustments of appliances, and supervision of all components of the service—if 1 appliance is used | 512.75 | 584.95 | |
| 75027 | 937.45 | Pre-surgical infant maxillary arch repositioning including nasoalveolar moulding, supply of appliances and all adjustments of appliances, and supervision of all components of the service—if 2 appliances are used | 703.1 | 838.75 | |
| 75030 | 834.7 | Maxillary arch expansion (other than a service associated with a service to which item 75039, 75042, 75045 or 75048 applies), including supply of appliances and all adjustments of appliances, removal of appliances and retention | 626.05 | 736 | |
| 75032 | 1879.35 | Mixed dentition treatment including incisor alignment (mandibular and/or maxillary) lateral arch expansion, including supply of appliances and all adjustments of appliances, removal of appliances and retention | 1409.55 | 1780.65 | |
| 75034 | 696.35 | Mixed dentition treatment—incisor alignment with or without lateral arch expansion using a removable appliance in the maxillary arch, including supply of all appliances, and associated adjustments and retention | 522.3 | 597.65 | |
| 75039 | 632.6 | Permanent dentition treatment—single arch (mandibular or maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances and aligners—initial 3 months of active treatment | 474.45 | 537.75 | |
| 75042 | 236.45 | Permanent dentition treatment—single arch (mandibular or maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances and aligners—each subsequent 3 months of active treatment (including all adjustments and maintenance and removal of the appliances) after the initial three months of active treatment for a maximum of a further 33 months | 177.35 | 201 | |
| 75045 | 1266.3 | Permanent dentition treatment—2 arch (mandibular and maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances or aligners—initial 3 months of active treatment | 949.75 | 1167.6 | |
| 75048 | 324.75 | Permanent dentition treatment—2 arch (mandibular and maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances or aligners—each subsequent 3 months of active treatment (including all adjustments and maintenance, and removal of the appliances) after the initial three months of active treatment for a maximum of a further 33 months | 243.6 | 276.05 | |
| 75049 | 380.1 | Retention, fixed or removable, single arch (mandibular or maxillary)—supply of retainer and supervision of retention | 285.1 | 323.1 | |
| 75050 | 733.7 | Retention, fixed or removable, 2‑arch (mandibular and maxillary)—supply of retainers and supervision of retention | 550.3 | 635 | |
| 75051 | 1126.3 | Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances | 844.75 | 1027.6 | |
| 75200 | 62.55 | Removal of tooth or tooth fragment (other than treatment to which item 75402 or 75405 applies) | 46.95 | 53.2 | |
| 75203 | 93.85 | Removal of tooth or tooth fragment under general anaesthesia | 70.4 | 79.8 | |
| 75206 | 31.15 | Removal of each additional tooth or tooth fragment if provided in association with a service to which item 75200 or 75203 applies | 23.4 | 26.5 | |
| 75400 | 187.7 | Surgical removal of erupted tooth | 140.8 | 159.55 | |
| 75402 | 185.5 | Surgical removal of tooth, or tooth fragment requiring incision of soft tissue only | 139.15 | 157.7 | |
| 75405 | 237.2 | Surgical removal of tooth, or tooth fragment requiring removal of bone, where the patient is referred by a referring dentist or medical practitioner | 177.9 | 201.65 | |
| 75600 | 264.35 | Surgical exposure and packing of unerupted tooth | 198.3 | 224.7 | |
| 75603 | 310.75 | Surgical exposure of unerupted tooth for the purpose of fitting a traction device or placement of a temporary anchorage device | 233.1 | 264.15 | |
| 75606 | 310.75 | Surgical repositioning of unerupted tooth where the patient is referred by a referring dentist or medical practitioner | 233.1 | 264.15 | |
| 75609 | 463.9 | Transplantation of tooth bud where the patient is referred by a referring dentist or medical practitioner | 347.95 | 394.35 | |
| 75610 | 393.3 | Surgical procedure for intraoral implantation of an osseointegrated fixture and placement of transmucosal abutments where the patient is referred by a referring dentist or medical practitioner | 295 | 334.35 | |
| 75618 | 263.8 | Fabrication and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome | 197.85 | 224.25 | |
| 75621 | 263.8 | The fabrication and fitting of surgical splint or guide in conjunction with orthognathic surgical procedures and implant treatment, if provided in association with a service to which: (a) any item in the following series applies: (i)any of items 46150 to 46161 apply; or (ii) any of items 52342 to 52375 apply; or (b) item 52380 or 52382 applies; (c) item 75610 applies | 197.85 | 224.25 | |
| 75800 | 93.85 | Attendance involving consultation, preventive treatment and prophylaxis, of not less than 30minutes in duration for each attendance to a maximum of 3attendances in any 12month period (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies) | 70.4 | 79.8 | |
| 75802 | 479.4 | Fabrication and fitting of acrylic base partial denture, including retainers—1 to 4 teeth | 359.55 | 407.5 | |
| 75815 | 707.35 | Fabrication and fitting of acrylic base partial denture, including retainers—5 to 9 teeth | 530.55 | 608.65 | |
| 75818 | 834.7 | Fabrication and fitting of acrylic base partial denture or complete denture or overdenture, including retainers—10 to 12 teeth | 626.05 | 736 | |
| 75820 | 831.95 | Fabrication and fitting of metal framework partial denture, including all components—1 to 4 teeth | 624 | 733.25 | |
| 75833 | 1205.7 | Fabrication and fitting of metal framework partial denture including all components—5 to 9 teeth | 904.3 | 1107 | |
| 75836 | 1379.7 | Fabrication and fitting of metal framework partial denture or complete denture or overdenture including all components—10 to 12 teeth | 1034.8 | 1281 | |
| 75842 | 46.4 | Adjustment of denture (other than a service associated with a service to which item 75802, 75815, 75818, 75820, 75833 or 75836 applies) | 34.8 | 39.45 | |
| 75845 | 232 | Relining of denture by laboratory process and associated fitting | 174 | 197.2 | |
| 75848 | 278.2 | Remodelling and fitting of denture of more than 4teeth | 208.65 | 236.5 | |
| 75851 | 139.15 | Repair to metal framework of denture—1 or more points | 104.4 | 118.3 | |
| 75854 | 139.15 | Addition of a tooth or teeth to a denture to replace extracted tooth or teeth, including taking of necessary impression | 104.4 | 118.3 |
Does my dentist need to be registered to provide services under MBS Category 7: Cleft and Craniofacial Services?
A practitioner is required to be registered with Services Australia through the Health Professional Online Services (HPOS). Guides are available on the Services Australia website to assist organisations and professionals to register and use HPOS.
Refer: Health Professional Online Services (HPOS)
There is no specific registration to be able to provide services under MBS Category 7: Cleft and Craniofacial Services. As providers do not need to register to provide Category 7 services, Medicare do not have a list of providers to give to patients. Practitioners do need to meet the eligibility criteria.
Refer: MBS Online: CN.2.1 Dental Practitioner Eligibility
Attachment: PDF Version – Information Sheet – Cleft and Craniofacial Services Practitioner eligibility – Effective 1 March 2024
What are the eligibility criteria for practitioners to provide services?
For the purposes of cleft and craniofacial services, groupings for eligible practitioners include the following:
- Dental practitioner: all registered dental practitioners, including practitioners who hold qualifications and are registered in the specialty of orthodontics, paediatric dentistry, oral and maxillofacial surgery, and prosthodontics.
- Eligible orthodontist: dental practitioners who are registered in the specialty of orthodontics and who hold qualifications as an orthodontic specialist can provide relevant Medicare Benefits Schedule (MBS) cleft and craniofacial services.
- Eligible prosthodontist: dental practitioners who are registered in the specialty of prosthodontics and who hold qualifications as a prosthodontic specialist can provide relevant MBS cleft and craniofacial services.
- Eligible paediatric dentist: dental practitioners who hold qualifications as a paediatric dentist and are registered in the specialty of paediatric dentistry can provide relevant MBS cleft and craniofacial services.
- Eligible oral and maxillofacial surgeon: oral and maxillofacial services may be performed, following a referral from a medical practitioner or referring dentist, by:
- medical practitioners who are specialists in the practice of their specialty of oral and maxillofacial surgery; or
- dental practitioners who were approved by the Minister prior to 1 November 2004 for the purposes of subsection 3 (1) of the Health Insurance Act 1973 (the Act) to carry out prescribed medical services (oral and maxillofacial surgery) contained in the MBS.
Refer: MBS Online: CN.2.1 Dental Practitioner Eligibility
To be considered ‘eligible’, practitioner qualifications must be recognised under National Law or grandfathered as outlined in the Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024.
- A practitioner is also required to be registered with Services Australia through the Health Professional Online Services (HPOS). Guides are available on the Services Australia website to assist organisations and professionals to register and use HPOS.
- Depending on the qualifications and recognition within the profession and the specialty or area of expertise recognised by the Australian Health Practitioner Regulation Agency, Services Australia will allocate access to the appropriate MBS items accordingly.
Refer: Information Sheet – Cleft and Craniofacial Services Practitioner eligibility – MBS Online Factsheets: March 2024 – Changes to Category 7 – Cleft and Craniofacial Services
Attachment: PDF Version – Information Sheet – Cleft and Craniofacial Services Practitioner eligibility – Effective 1 March 2024
What information needs to be on my itemised account/receipt to submit a claim for Medicare benefits in Category 7: Cleft and Craniofacial Services?
The patient needs a properly itemised account/receipt to enable a claim to be made for Medicare benefits.
- MBS Item Number
- Patient’s name;
- The date on which the professional service was rendered;
- A description of the professional service sufficient to identify the item that relates to that service, including an indication where the service is rendered to a person while hospital treatment is provided in a hospital or day-hospital facility (other than a Medicare hospital patient), that is, the words (ie, accommodation and nursing care) “admitted patient” immediately preceding the description of the service or an asterisk “*” directly after an item number where used;
- The name and practice address or name and provider number of the practitioner who actually rendered the service; (Where the practitioner has more than one practice location recorded with Services Australia, the provider number used should be that which is applicable to the practice location at or from which the service was given).
- Cleft or Craniofacial patient certification – A medical or dental practitioner must notate ‘certified dental patient‘ on the patient’s account or include ‘certified dental patient’ in the text field when submitting a Medicare claim for benefits.
What was the Taskforce Review
The Cleft Dental Services Working Group (the Working Group) was established in 2018 to make recommendations to the Taskforce on MBS items in its area of responsibility, based on rapid evidence review and clinical expertise.
The Working Group was tasked with reviewing MBS items included under Category 7: Cleft Lip and Cleft Palate Services.
Refer: DoHAC: Final report from the Cleft Dental Services Working Group
What was the outcome of the Taskforce Review
After considering the 62 items in scope, the Working Group made 29 recommendations to modernise the MBS and ensure items reflect contemporary practice.
Refer: DoHAC: Final report from the Cleft Dental Services Working Group
Of the 29 Recommendations made:
- 23 Recommendations were implemented
- Recommendation 3 was amended by the implementation liaison group (ILG) and removed all age restrictions associated with the Scheme. This was implemented on 1 November 2023.
- Recommendations 1, 2, 5-10, 12, 14-16, 18-27 were implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973.
- 1 Recommendation became unnecessary due to other amened and implemented recommendation
- Recommendation 4 was not adopted. With the removal of age restrictions, registration became unnecessary. Eligibility has been opened to people of all ages with eligible conditions (Recommendation 3).
- 1 Recommendation was not adopted
- Recommendation 11 was not adopted as dental specialists can access CBCT through existing MBS items, and a specific cleft and craniofacial item is not required.
- 2 Recommendations required no implementation
- Recommendation 13 and 17, no implementation was required.
- 2 Recommendations are under further consideration by Government
- Recommendations 28 and 29 are under consideration by Government.
Attachment: PDF Version – Changes to Category 7 – Cleft and Craniofacial Services – Effective 1 March 2024
The table below provides a high level view of each recommendation in the report.
| Category | Recommendation | Implementation / Notes |
|---|---|---|
| Overarching recommendations | Recommendation 1 – Official name of the Scheme and Category 7 of the MBS | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. |
| Recommendation 2 – Clinical indications for patient eligibility | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. | |
| Recommendation 3 – Patient eligibility age restriction | Recommendation 3 was amended by the implementation liaison group (ILG) and removed all age restrictions associated with the Scheme. This was Implemented on 1 November 2023. Note: Eligibility for Medicare benefits under the scheme was not backdated prior to the removal of age restrictions on 1 November 2023. Any treatments delivered prior to 1 November 2023 are subject to the policy and legislation at the time of treatment and unfortunately not eligible for Medicare benefits. |
|
| Recommendation 4 – Registration process of eligible patients | Recommendation 4 was not adopted. With the removal of age restrictions, registration became unnecessary. Eligibility has been opened to people of all ages with eligible conditions (Recommendation 3). | |
| Grouping of items and dental practitioner access | Recommendation 5 – Groupings and dental practitioner access | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. |
| Consultations | Recommendation 6 – Standard attendances | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. New MBS Item 75002 – Consolidated old item 75001 and 75150 New MBS Item 75005 – Consolidated old item 75004 and 75153 |
| Attendance involving consultation, preventive treatment and prophylaxis | Recommendation 7 – Attendance by registered dentist | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. |
| Dental Study Models | Recommendation 8 – Dental study models | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. New MBS Item 75007 – Consolidated old item 75006 and 75156 |
| Recommendation 9 – Study model materials | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. | |
| Orthodontic Services (C1) | Recommendation 10 – Radiography items | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. |
| Recommendation 11 – Cone beam computed tomography | Recommendation 11 was not adopted as dental specialists can access CBCT through existing MBS items, and a specific cleft and craniofacial item is not required. | |
| Recommendation 12 – Presurgical infant maxillary arch repositioning | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. | |
| Recommendation 13 – Maxillary arch expansion | Recommendation 13, no implementation was required. | |
| Recommendation 14 – Mixed dentition treatment | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. New MBS Item 75032 – Consolidated old item 75033, 75036 and 75037 |
|
| Recommendation 15 – Permanent dentition treatment | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. | |
| Recommendation 16 – Supply of retainers and supervision of retention | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. | |
| Recommendation 17 – Jaw growth guidance | Recommendation 17, no implementation was required. | |
| Oral and Maxillofacial Services (C2) | Recommendation 18 – Referral requirements | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. |
| Recommendation 19 – Simple extractions | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. | |
| Recommendation 20 – Surgical extractions | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. New MBS Item 75402 – Consolidated old item 75403 and 75412 New MBS Item 75405 – Consolidated old item 75406, 75409, and 75415 |
|
| Recommendation 21 – Surgical procedures for unerupted tooth and transplantation of tooth bud | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. | |
| Recommendation 22 – Other surgical procedures | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. New MBS Item 75610 – Consolidated old item 75612 and 75615 |
|
| General and Prosthodontic Services (C3) | Recommendation 23 – Production of individual specialised dental products | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. |
| Recommendation 24 – Acrylic base dentures | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. New MBS Item 75802 – Consolidated old item 75803, 75806, 75809, and 75812 |
|
| Recommendation 25 – Metal framework dentures | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. New MBS Item 75820 – Consolidated old item 75821, 75824, 75827, and 75830 |
|
| Recommendation 26 – Provision and fitting of retainers | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. | |
| Recommendation 27 – Miscellaneous denture procedures | Implemented on 1 March 2024, noting there may have been different language used due to refinement by the ILG and legislative requirements to align to the language under the Health Insurance Act 1973. | |
| Recommendation 28 – Fabrication and fitting of prostheses | Recommendations 28 and 29 are under consideration by Government. | |
| Recommendation 29 – Prosthodontic implant procedures |
New items mapping to old items and associated recommendation number are provided below for reference:
| Recommendation Number | New MBS item | Consolidated old items |
|---|---|---|
| 6 | 75002 | Consolidated items 75001 and 75150 |
| 6 | 75005 | Consolidated items 75004 and 75153 |
| 8 | 75007 | Consolidated items 75006 and 75156 |
| 14 | 75032 | Consolidated items 75033, 75036 and 75037 |
| 20 | 75402 | Consolidated items 75403 and 75412 |
| 20 | 75405 | Consolidated items 75406, 75409, and 75415 |
| 22 | 75610 | Consolidate items 75612 and 75615 |
| 24 | 75802 | Consolidate items 75803, 75806, 75809, and 75812 |
| 25 | 75820 | Consolidated items 75821, 75824, 75827, and 75830 |
What is the status of the Taskforce recommendations 28 & 29 that were not implemented on 1 Nov 2023 & 1 Mar 2024
These recommendations, if approved for implementation, would require additional funding as they seek to list new items on the MBS. The process for listing new items on the MBS involves consideration by the Medical Services Advisory Committee (MSAC). The usual MSAC application process is described on the MSAC webpage.
The Department of Health & Aged Care (DoHAC) is seeking the advice of the MSAC Executive regarding recommendations 28 and 29 of the cleft review. MSAC advice is then subject to consideration by the Minister for Health and the government for potential inclusion on the MBS.
Refer: ozED are in contact with The Department of Health & Aged Care (DoHAC) to gain updates on the status of these recommendations as they progress through the process.
Can ozED advocate or support me when discussing treatment with my provider
Yes, ozED provides advocacy and support to our members when you need. Simply reach out via email info@ozed.org.au requesting advocacy and representation support
Refer: https://www.ozed.org.au/about-us/ and https://www.ozed.org.au/become-a-member/
If you have further questions relating to MBS Category 7: Cleft and Craniofacial Services, please contact:
Patients
If you are a patient seeking advice about Medicare services, patient benefits (rebates), or your Medicare claims, please contact Services Australia on the Medicare General enquiry line – 13 20 11.
If you have a query that was unable to be answered by the Medicare General enquiry line, it is recommended that you advise the call agent that you are stuck and ask to speak with the Social Worker or Mental Health Worker – these 2 roles will be able to assist in taking time to go through your queries and where you are stuck on getting information.
Practitioners / Providers
If you are seeking advice in relation to Medicare billing, claiming, payments or obtaining a provider number, please contact Services Australia on the Provider Enquiry Line – 13 21 50.
If you have a query relating exclusively to interpretation of the Schedule, you should email – askMBS@health.gov.au.
If you require assistance regarding claiming or registering with HPOS, please contact Services Australia on 13 21 50.
Practitioners and Providers may also find the below links helpful:
Health Professional Education Resources (servicesaustralia.gov.au)
- Health Professional Online Services (HPOS)
- Child Dental Benefits Schedule (CDBS) – Health Professional Education Resources (servicesaustralia.gov.au)
- whilst this page is specific to the CDBS some of the resources are also relevant to Category 7.
- Provider Eligibility – Health Professional Education Resources (servicesaustralia.gov.au)
- Provider and prescriber numbers
Submit a Question
Do you have a question that hasn’t been answered above?
Submit your question below and we will provide a response.
Relevant Links:
MBS Online Factsheets: November 2023 – Expanding patient access to Cleft Dental Services
MBS Online Factsheets: March 2024 – Changes to Category 7 – Cleft and Craniofacial Services
MBS Online Category 7: Cleft and Craniofacial Services
Services Australia: Claim for cleft and craniofacial condition services
MBS Online: July 2024 Downloads
Create Publication | Medicare Benefits Schedule (health.gov.au)
DoHAC: Final report from the Cleft Dental Services Working Group
Medical Services Advisory Committee (MSAC)
Health Professional Education Resources (servicesaustralia.gov.au)
Health Professional Online Services (HPOS)
Provider Eligibility – Health Professional Education Resources (servicesaustralia.gov.au)
