Medicare Benefits Schedule - Item 75200

Search Results for Item 75200

View Associated Notes

Category 7 - CLEFT AND CRANIOFACIAL SERVICES

75200

75200 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Group
C1 - Cleft and Craniofacial Services

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)


Associated Notes

Category 7 - CLEFT AND CRANIOFACIAL SERVICES

CN.0.8

Multiple Operation Rule

The Schedule fee for two or more operations performed on a patient on the one occasion is calculated by the following rule:

ยท 100% for the item with the greatest Schedule fee, plus 50% for the item with the next greatest Schedule fee, plus 25% for each other item. 

NOTE:           

1.         Fees so calculated which result in a sum which is not a multiple of 5 cents are taken to the next higher multiple of 5 cents.

2.         Where two or more operations performed on the one occasion have fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts.

3.         The Schedule fee for benefits purposes is the aggregate of the fees calculated in accordance with the above formula. 

The above rule does not apply to an operation which is one of two or more operations performed under the one anaesthetic on the same patient by different dental practitioners unless either practitioner assists the other. In this case, the fees and benefits specified in the Schedule apply. For these purposes the term "operation" includes items 75200 to 75610.

If the operation comprises a combination of procedures which are commonly performed together and for which a specific combined item is provided in the Schedule, it is regarded as the one item and service in applying the multiple operation rule.

Related Items: 75200 75203 75206 75400 75402 75405 75600 75603 75606 75609 75610

Category 7 - CLEFT AND CRANIOFACIAL SERVICES

CN.2.1

Dental Practitioner Eligibility

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


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change