Medicare Benefits Schedule - Note CN.3.1

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Patient Eligibility

To be eligible to claim benefits for cleft dental services performed by eligible medical and dental practitioners, a patient must satisfy the following criteria:

a. The patient must be an Australian resident or any other person or class of persons whom the Minister declares to be eligible. All eligible persons will be issued with a Medicare card on application as evidence of their eligibility.

 b. The patient must be diagnosed with an eligible cleft or craniofacial condition specified in the Health Insurance (Section 3C Cleft Lip and Cleft Palate Services) Determination 2020.

The Health Insurance (Section 3C Cleft Lip and Cleft Palate Services) Determination 2020, specifies the eligible cleft or craniofacial conditions listed below:

1. Oral and/or facial clefting
Limited to Cleft lip, alveolus and/or palate
  Tessier facial cleft
2. Congenital or hereditary craniofacial malformation, deformation or disruption
Limited to Achondroplasia
  Branchial arch disorders including: Hemifacial/craniofacial microsomia, Goldenhar syndrome, DiGeorge syndrome, Velocardiofacial syndrome
  CHARGE syndrome
  Congenital hemifacial hyperplasia
  Congenital lymphatic and/or vascular malformations of the head & neck, cystic hygroma, Sturge-Weber syndrome, excluding haemangiomas, birth marks and naevi.
  Craniofacial Neurofibromatosis Type 1
  Craniometaphyseal dysplasia
  Ectodermal dysplasia
  Hemifacial atrophy (Parry Romberg syndrome)
  Mandibulofacial dysostosis (Treacher Collins syndrome)
  Maxillonasal dysplasia (Binder syndrome)
  Oral-facial digital syndrome Type 1
  Pierre Robin sequence
  Rubinstein-Taybi syndrome
  Shprintzen-Goldberg syndrome
  Solitary median maxillary central incisor syndrome
  Stickler syndrome
  Syndromic craniosynostoses including:
Apert, Crouzon, Pfeiffer, Saethre Chotzen, and Muenke syndromes
  Trichorhinophalangeal syndrome Type 1
3. Hereditary conditions presenting with the absence of 6 (six) or more permanent teeth, excluding 3rd molars
4. Hereditary conditions where the presence of supernumerary teeth is a major feature
Limited to Cleidocranial dysplasia
  Gardner's syndrome
5. Hereditary conditions affecting the formation of enamel and/or dentine of all teeth
Limited to Amelogenesis imperfecta
  Dentinogenesis imperfecta
  Regional odontodysplasia



  • 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