Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024

law://au/li/2024/f2024l00110@2026-11-13

Contents

1 Name #

This instrument is the Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024.

3 Authority #

This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4 Definitions #

(1) In this instrument:

Act means the Health Insurance Act 1973.

dental practitioner has the same meaning as subsection 3(1) of the Act.

eligible oral and maxillofacial surgeon means a dental practitioner who is recognised under the National Law in the speciality of oral and maxillofacial surgery.

eligible orthodontist means:

(a) a dental practitioner who is registered under National Law in the speciality of orthodontics; or

(b) a dental practitioner whose qualifications or experience were recognised by the Australian Society of Orthodontists, prior to 31 March 2013, as applicable to:

i. services mentioned in items 75002, 75005, 75007, 75012, 75015, and 75024 to 75051; or

ii. services mentioned in at least one of these items; or

(c) a dental practitioner who, immediately prior to 1 November 2012, was a registered orthodontist as defined in rule 2.59.2(3)(b) of the general medical services table or any equivalent provision of preceding regulations.

Note: In this section, an equivalent provision of preceding regulations means a provision of regulations prescribed pursuant to section 4 of the Act in force at any time prior to the commencement of the general medical services table, being a provision concerning the accreditation of a dental practitioner who was not registered or licensed as an orthodontist under a law of a State or Territory that provided for the registration or licensing of orthodontists.

eligible paediatric dentist means a dental practitioner who is recognised under the National Law in the speciality of paediatric dentistry.

eligible prosthodontist means a dental practitioner who is recognised under the National Law in the speciality of prosthodontics.

medical practitioner has the same meaning as subsection 3(1) of the Act.

referring dentist means a dental practitioner who is recognised under the National Law in the dentists division of the dental profession.

relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the table at Schedule 2.

Schedule means a Schedule to this instrument.

Note: Unless the contrary intention appears, expressions used in this instrument have the same meanings as in the Act—see section 13 of the Legislation Act 2003. Terms defined in the Act include:

 general medical services table

 item

 National Law

 professional service

(2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

5 Schedules #

Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

6 Relevant services #

For subsection 3C(1) of the Act, a relevant service provided in accordance with this instrument is to be treated, for the relevant provisions, as if:

(a)it were both a professional service and a medical service; and

(b)there were an item in the general medical services table that:

(i)related to the service; and

(ii)specified for the service a fee in relation to each State, being the fee specified in Schedule 1 in relation to the service.

7 Limitation on services #

(1) An item specified in Schedule 1 to this Determination only applies to a service provided to a patient with an eligible cleft or craniofacial condition, as specified in the table at Schedule 2.

(2) Items 75009, 75010, 75011,75023, 75200, 75203, 75206, 75400, 75402, 75800, 75802, 75815, 75818, 75820, 75833, 75836, 75842, 75845, 75848, 75851 and 75854 apply to a service provided by a dental practitioner.

(3) Items 75002, 75005, 75007, 75012, 75015, 75024, 75027, 75030, 75032, 75034, 75039, 75042, 75045, 75048, 75049, 75050, 75051, 75618 and 75621 apply to a service provided by an eligible orthodontist.

(4) Items 75002, 75005, 75007, 75618 and 75621 apply to a service provided by an eligible prosthodontist.

(5) Items 75002, 75005, 75007, 75024, 75027, 75600 and 75603 apply to a service provided by an eligible paediatric dentist.

(6) Items 75002, 75005, 75007, 75012, 75015, 75405, 75600, 75603, 75606, 75609, 75610, 75618 and 75621 apply to a service provided by:

(a)an eligible oral and maxillofacial surgeon; or

(b)a dental practitioner 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.

8 Requirement for referral by a referring dentist or medical practitioner #

(1) 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.

9 Indexation #

(1) At the start of 1 July 2026 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:

Note: The indexed fees could in 2026 be viewed on the Department of Health, Disability and Ageing’s MBS Online website (www.mbsonline.gov.au).

(2) The amounts covered by this subsection are the fee for each item in Schedule 1 of this Determination.

(3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).

Schedule 1—Specified health services

Group C1—Cleft and Craniofacial Services
Item	Service	Fee ($)
75002	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)	94.10
75005	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)	47.35
75007	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	83.85
75009	Orthodontic radiography—orthopantomography (panoramic radiography), including any consultation on the same occasion	75.05
75010	Orthodontic radiography – anteroposterior or lateral cephalometric radiography, with cephalometric tracings, and orthopantomography, including any consultation on the same occasion	151.80
75011	Orthodontic radiography – anteroposterior and lateral cephalometric radiography, with cephalometric tracings, and orthopantomography, including any consultation on the same occasion	197.90
75012	Orthodontic anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion	118.95
75015	Radiography anteroposterior and lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion	163.50
75023	Intraoral radiography—single area, periapical or bitewing film	51.10
75024	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	660.55
75027	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	905.75
75030	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	806.45
75032	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	1815.80
75034	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	672.80
75039	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	611.20
75042	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	228.45
75045	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	1,223.50
75048	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	313.75
75049	Retention, fixed or removable, single arch (mandibular or maxillary)—supply of retainer and supervision of retention	367.25
75050	Retention, fixed or removable, 2-arch (mandibular and maxillary)—supply of retainers and supervision of retention	708.90
75051	Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances	1,088.20
75200	Removal of tooth or tooth fragment (other than treatment to which item 75402 or 75405 applies)	60.45
75203	Removal of tooth or tooth fragment under general anaesthesia (H)	90.70
75206	Removal of each additional tooth or tooth fragment if provided in association with a service to which item 75200 or 75203 applies	30.10
75400	Surgical removal of erupted tooth	181.35
75402	Surgical removal of tooth, or tooth fragment requiring incision of soft tissue only	179.25
75405	Surgical removal of tooth, or tooth fragment requiring removal of bone, where the patient is referred by a referring dentist or medical practitioner	229.20
75600	Surgical exposure and packing of unerupted tooth	255.40
75603	Surgical exposure of unerupted tooth for the purpose of fitting a traction device or placement of a temporary anchorage device	300.25
75606	Surgical repositioning of unerupted tooth where the patient is referred by a referring dentist or medical practitioner	300.25
75609	Transplantation of tooth bud where the patient is referred by a referring dentist or medical practitioner	448.20
75610	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 (H)	380.00
75618	Fabrication and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome	254.90
75621	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	254.90
75800	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)	90.70
75802	Fabrication and fitting of acrylic base partial denture, including retainers—1 to 4 teeth	463.20
75815	Fabrication and fitting of acrylic base partial denture, including retainers—5 to 9 teeth	683.45
75818	Fabrication and fitting of acrylic base partial denture or complete denture or overdenture, including retainers—10 to 12 teeth	806.45
75820	Fabrication and fitting of metal framework partial denture, including all components—1 to 4 teeth	803.80
75833	Fabrication and fitting of metal framework partial denture including all components—5 to 9 teeth	1,164.95
75836	Fabrication and fitting of metal framework partial denture or complete denture or overdenture including all components—10 to 12 teeth	1,333.05
75842	Adjustment of denture (other than a service associated with a service to which item 75802, 75815, 75818, 75820, 75833 or 75836 applies)	44.85
75845	Relining of denture by laboratory process and associated fitting	224.15
75848	Remodelling and fitting of denture of more than 4 teeth	268.80
75851	Repair to metal framework of denture—1 or more points	134.45
75854	Addition of a tooth or teeth to a denture to replace extracted tooth or teeth, including taking of necessary impression	134.45

Schedule 2—Eligible cleft or craniofacial conditions

Table 9– Eligible cleft or craniofacial conditions
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, birthmarks, 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 3^rd 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

Sourced from the Federal Register of Legislation at legislation.gov.au, © Commonwealth of Australia, licensed under CC BY 4.0. Compilations may have been reformatted.

Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024

Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024

1 Name #

3 Authority #

4 Definitions #

5 Schedules #

6 Relevant services #

7 Limitation on services #

8 Requirement for referral by a referring dentist or medical practitioner #

9 Indexation #

Schedule 1—Specified health services

Schedule 2—Eligible cleft or craniofacial conditions

Connections

History · 1 version

Key facts

1 Name #

3 Authority #

4 Definitions #

5 Schedules #

6 Relevant services #

7 Limitation on services #

8 Requirement for referral by a referring dentist or medical practitioner #

9 Indexation #

Schedule 1—Specified health services

Schedule 2—Eligible cleft or craniofacial conditions