Eligible health professionals include:
- orthodontists
- oral and maxillofacial surgeons
- dentists.
You must be registered with us for cleft and craniofacial services to attract Medicare benefits. You can read how to start with Medicare.
Category 7 of the Medicare Benefits Schedule (MBS) covers all of the following:
- Group C1 - Orthodontic services.
- Group C2 - Oral and maxillofacial surgical services.
- Group C3 - General and prosthodontic services.
For information on cleft and craniofacial services, visit the MBS Online website.
To be eligible for treatment, your patient must meet the following criteria:
- be enrolled in Medicare
- be certified by a health professional as having a cleft lip, a cleft palate or another eligible craniofacial condition.
Some Medicare items need a referral. For example, oral and maxillofacial service items need a referral from an orthodontist.
When providing treatment, you must certify in your claims that your patient meets all of the eligibility requirements of a patient with a cleft or craniofacial condition.
You’ll need to include the text ‘certified dental patient’ on the patient’s account or in the text field of a Medicare claim for benefits.
For information on eligible conditions, visit the MBS Online website.