Medicare Benefits Schedule - Note CN.3.1

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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



  • 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