Category 7 - CLEFT AND CRANIOFACIAL SERVICES
CN.3.1
Patient Eligibility
To be eligible to claim benefits for cleft and dental services performed by eligible medical and registered 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; and
b. The patient must be diagnosed with an eligible cleft or craniofacial condition specified in the Health Insurance (Section 3C General Medical Services - Cleft and Craniofacial Services) Determination 2024.
The Health Insurance (Section 3C General Medical Services - Cleft and Craniofacial Services) Determination 2024 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, Auriculo-condylar 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 | |
Congenital lymphatic and vascular malformations and segmental haemangiomas involving the jaws and associated soft tissues including cystic hygroma and Sturge-Weber syndrome | |
Ectodermal dysplasia | |
Hemifacial atrophy (Parry Romberg syndrome) | |
Mandibulofacial dysostosis (Treacher Collins syndrome) | |
Maxillonasal dysplasia (Binder syndrome) | |
Oral-facial digital syndrome Type 1 | |
Osteogenesis imperfercta | |
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. Development or hereditary conditions affecting the formation of enamel and/or dentine of all teeth | |
Limited to | Amelogenesis imperfecta |
Dentinogenesis imperfecta | |
Regional odontodysplasia |
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