Medicare Benefits Schedule - Note CN.2.1

In order to attract Medicare benefits, all treatment must be carried out by eligible medical practitioners or eligible dental practitioners in Australia. For the purposes of cleft and craniofacial services, groupings for eligible practitioners include:

-   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.

Dental practitioners who were previously accredited to provide cleft and craniofacial services who do not meet the registration requirements as a dental practitioner will be grandfathered under legislative arrangements that came into force on 1 November 2012. 

All eligible dental practitioners are entitled to perform services covered by items 75009, 75023, 75200, 75203, 75206, 75400, 75402, 75800, 75802, 75815, 75818, 75820, 75833, 75836, 75842, 75845, 75848, 75851 and 75854.

All eligible orthodontists are entitled to perform services covered by items 75002, 75005, 75007, 75012, 75015, 75024, 75027, 75030, 75032, 75034, 75039, 75042, 75045, 75048, 75049, 75050, 75051, 75618 and 75621.

All eligible prosthodontists are entitled to perform services covered by items 75002, 75005, 75007, 75618 and 75621.

All eligible paediatric dentists are entitled to perform services covered by items 75002, 75005, 75007, 75024, 75027, 75600 and 75603.

All eligible oral and maxillofacial surgeons and dental practitioners who, immediately prior to 1 November 2012, held an approval granted by the Minister for the purposes of the definition of professional service in subsection 3(1) of the Act, are entitled to perform services covered by items 75002, 75005, 75007, 75012, 75015, 75405, 75600, 75603, 75606, 75609, 75610, 75618 and 75621.

Items 75002, 75005, 75200, 75203, 75206, 75400, 75402, 75600, 75603, 75618 and 75621 apply only to a service provided by an eligible oral and maxillofacial surgeon if the patient has been referred by a referring dentist or medical practitioner. 

Related Items: 75002 75005 75007 75009 75012 75015 75023 75024 75027 75030 75032 75034 75039 75042 75045 75048 75049 75050 75051 75200 75203 75206 75400 75402 75405 75600 75603 75606 75609 75610 75618 75621 75800 75802 75815 75818 75820 75833 75836 75842 75845 75848 75851 75854

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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)

Fee: $94.10 Benefit: 75% = $70.60 85% = $80.00

(See para CN.2.1 of explanatory notes to this Category)

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)

Fee: $47.35 Benefit: 75% = $35.55 85% = $40.25

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $83.85 Benefit: 75% = $62.90 85% = $71.30

(See para CN.0.10, CN.2.1 of explanatory notes to this Category)

Orthodontic radiography—orthopantomography (panoramic radiography), including any consultation on the same occasion

Fee: $75.05 Benefit: 75% = $56.30 85% = $63.80

(See para CN.2.1 of explanatory notes to this Category)

Orthodontic anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion

Fee: $118.95 Benefit: 75% = $89.25 85% = $101.15

(See para CN.2.1 of explanatory notes to this Category)

Radiography anteroposterior and lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion

Fee: $163.50 Benefit: 75% = $122.65 85% = $139.00

(See para CN.2.1 of explanatory notes to this Category)

Intraoral radiography—single area, periapical or bitewing film

Fee: $51.10 Benefit: 75% = $38.35 85% = $43.45

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $660.55 Benefit: 75% = $495.45 85% = $561.85

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $905.75 Benefit: 75% = $679.35 85% = $807.05

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $806.45 Benefit: 75% = $604.85 85% = $707.75

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $1,815.80 Benefit: 75% = $1,361.85 85% = $1,717.10

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $672.80 Benefit: 75% = $504.60 85% = $574.10

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $611.20 Benefit: 75% = $458.40 85% = $519.55

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $228.45 Benefit: 75% = $171.35 85% = $194.20

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $1,223.50 Benefit: 75% = $917.65 85% = $1,124.80

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $313.75 Benefit: 75% = $235.35 85% = $266.70

(See para CN.2.1 of explanatory notes to this Category)

Retention, fixed or removable, single arch (mandibular or maxillary)—supply of retainer and supervision of retention

Fee: $367.25 Benefit: 75% = $275.45 85% = $312.20

(See para CN.2.1 of explanatory notes to this Category)

Retention, fixed or removable, 2‑arch (mandibular and maxillary)—supply of retainers and supervision of retention

Fee: $708.90 Benefit: 75% = $531.70 85% = $610.20

(See para CN.2.1 of explanatory notes to this Category)

Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances

Fee: $1,088.20 Benefit: 75% = $816.15 85% = $989.50

(See para CN.2.1 of explanatory notes to this Category)

Removal of tooth or tooth fragment (other than treatment to which item 75402 or 75405 applies)

Fee: $60.45 Benefit: 75% = $45.35 85% = $51.40

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Removal of tooth or tooth fragment under general anaesthesia

Fee: $90.70 Benefit: 75% = $68.05 85% = $77.10

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Removal of each additional tooth or tooth fragment if provided in association with a service to which item 75200 or 75203 applies

Fee: $30.10 Benefit: 75% = $22.60 85% = $25.60

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical removal of erupted tooth

Fee: $181.35 Benefit: 75% = $136.05 85% = $154.15

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical removal of tooth, or tooth fragment requiring incision of soft tissue only

Fee: $179.25 Benefit: 75% = $134.45 85% = $152.40

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical removal of tooth, or tooth fragment requiring removal of bone, where the patient is referred by a referring dentist or medical practitioner

Fee: $229.20 Benefit: 75% = $171.90 85% = $194.85

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical exposure and packing of unerupted tooth

Fee: $255.40 Benefit: 75% = $191.55 85% = $217.10

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical exposure of unerupted tooth for the purpose of fitting a traction device or placement of a temporary anchorage device

Fee: $300.25 Benefit: 75% = $225.20 85% = $255.25

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical repositioning of unerupted tooth where the patient is referred by a referring dentist or medical practitioner

Fee: $300.25 Benefit: 75% = $225.20 85% = $255.25

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Transplantation of tooth bud where the patient is referred by a referring dentist or medical practitioner

Fee: $448.20 Benefit: 75% = $336.15 85% = $381.00

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

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

Fee: $380.00 Benefit: 75% = $285.00 85% = $323.00

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Fabrication and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome

Fee: $254.90 Benefit: 75% = $191.20 85% = $216.70

(See para CN.2.1 of explanatory notes to this Category)

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

Fee: $254.90 Benefit: 75% = $191.20 85% = $216.70

(See para CN.0.11, CN.2.1 of explanatory notes to this Category)

Attendance involving consultation, preventive treatment and prophylaxis, of not less than 30 minutes in duration for each attendance to a maximum of 3 attendances in any 12 month period (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies)

Fee: $90.70 Benefit: 75% = $68.05 85% = $77.10

(See para CN.0.12, CN.2.1 of explanatory notes to this Category)

Fabrication and fitting of acrylic base partial denture, including retainers—1 to 4 teeth

Fee: $463.20 Benefit: 75% = $347.40 85% = $393.75

(See para CN.2.1 of explanatory notes to this Category)

Fabrication and fitting of acrylic base partial denture, including retainers—5 to 9 teeth

Fee: $683.45 Benefit: 75% = $512.60 85% = $584.75

(See para CN.2.1 of explanatory notes to this Category)

Fabrication and fitting of acrylic base partial denture or complete denture or overdenture, including retainers—10 to 12 teeth

Fee: $806.45 Benefit: 75% = $604.85 85% = $707.75

(See para CN.2.1 of explanatory notes to this Category)

Fabrication and fitting of metal framework partial denture, including all components—1 to 4 teeth

Fee: $803.80 Benefit: 75% = $602.85 85% = $705.10

(See para CN.2.1 of explanatory notes to this Category)

Fabrication and fitting of metal framework partial denture including all components—5 to 9 teeth

Fee: $1,164.95 Benefit: 75% = $873.75 85% = $1,066.25

(See para CN.2.1 of explanatory notes to this Category)

Fabrication and fitting of metal framework partial denture or complete denture or overdenture including all components—10 to 12 teeth

Fee: $1,333.05 Benefit: 75% = $999.80 85% = $1,234.35

(See para CN.2.1 of explanatory notes to this Category)

Adjustment of denture (other than a service associated with a service to which item 75802, 75815, 75818, 75820, 75833 or 75836 applies)

Fee: $44.85 Benefit: 75% = $33.65 85% = $38.15

(See para CN.2.1 of explanatory notes to this Category)

Relining of denture by laboratory process and associated fitting

Fee: $224.15 Benefit: 75% = $168.15 85% = $190.55

(See para CN.2.1 of explanatory notes to this Category)

Remodelling and fitting of denture of more than 4 teeth

Fee: $268.80 Benefit: 75% = $201.60 85% = $228.50

(See para CN.2.1 of explanatory notes to this Category)

Repair to metal framework of denture—1 or more points

Fee: $134.45 Benefit: 75% = $100.85 85% = $114.30

(See para CN.2.1 of explanatory notes to this Category)

Addition of a tooth or teeth to a denture to replace extracted tooth or teeth, including taking of necessary impression

Fee: $134.45 Benefit: 75% = $100.85 85% = $114.30

(See para CN.2.1 of explanatory notes to this Category)