Health Insurance (Section 3C General Medical Services – Cleft Lip and Cleft Palate Services) Amendment Determination 2019 (Cth)
Health Insurance (Section 3C General Medical Services – Cleft Lip and Cleft Palate Services) Amendment Determination 2019
I, ELIZABETH DOWD, delegate of the Minister for Health, make this Determination.
Dated 5 April 2019
Elizabeth Dowd
Assistant Secretary
MBS Policy and Specialist Services Branch
Medical Benefits Division
Health Financing Group
Department of Health
Contents
1. Name
2. Commencement
3. Authority
4. Schedules
Schedule 1 – Amendments
Health Insurance (Cleft Lip and Cleft Palate Services) Determination 2012
Name
This Determination is the Health Insurance (Section 3C General Medical Services – Cleft Lip and Cleft Palate Services) Amendment Determination 2019.
Commencement
(1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.
| Commencement information | ||
| Column 1 | Column 2 | Column 3 |
| Provisions | Commencement | Date/Details |
| 1. The whole of this instrument | 1 July 2019 | |
Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.
(2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.
Authority
This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.
Schedules
Each instrument that is specified in a Schedule to this Determination is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Determination has effect according to its terms.
Schedule 1 – Amendments
Health Insurance (Cleft Lip and Cleft Palate Services) Determination 2012
Part 1 of the Schedule (below the heading)
Repeal the table, substitute:
| Category 7 – Cleft Lip and Cleft Palate Services | ||
| Group C1 – Orthodontic Services | ||
| Item | Service | Fee ($) |
| 75001 | Initial professional attendance in a single course of treatment by an eligible orthodontist (AO) | 86.90 |
| 75004 | Professional attendance by an eligible orthodontist after the first professional attendance by the orthodontist in a single course of treatment (AO) | 43.70 |
| 75006 | Production of dental study models (other than a service associated with a service to which item 75004 applies) before provision of a service to which: (a) item 75030, 75033, 75034, 75036, 75037, 75039, 75045 or 75051 applies; or (b) an item in Group T8 or Groups O3 to O9 applies; in a single course of treatment (AO) | 77.45 |
| 75009 | Orthodontic radiography — orthopantomography (panoramic radiography), including any consultation on the same occasion (AOS) (AO) | 69.25 |
| 75012 | Orthodontic radiography — anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings including any consultation on the same occasion (AOS) (AO) | 109.80 |
| 75015 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings including any consultation on the same occasion (AOS) (AO) | 150.95 |
| 75018 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography including any consultation on the same occasion (AOS) (AO) | 192.30 |
| 75021 | Orthodontic radiography — hand‑wrist studies (including growth prediction) including any consultation on the same occasion (AOS) (AO) | 235.75 |
| 75023 | Intraoral radiography — single area, periapical or bitewing film (AOS) (AO) | 47.20 |
| 75024 | Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 1 appliance is used (AO) | 609.70 |
| 75027 | Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 2 appliances are used (AO) | 836.05 |
| 75030 | Maxillary ach expansion other than a service associated with a service to which item 75039, 75042, 75045 or 75048 applies, including supply of appliances, all adjustments of the appliances, removal of the appliances and retention (AO) | 744.40 |
| 75033 | Mixed dentition treatment — incisor alignment using fixed appliances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of the appliances and retention (AO) | 1,220.15 |
| 75034 | Mixed dentition treatment — incisor alignment with or without lateral arch expansion using a removable appliance in the maxillary arch, including supply of appliances, associated adjustments and retention (AO) | 621.05 |
| 75036 | Mixed dentition treatment — lateral arch expansion and incisor alignment using fixed appliances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of appliances and retention (AO) | 1,685.30 |
| 75037 | Mixed dentition treatment — lateral arch expansion and incisor correction — 2 arch (maxillary and mandibular) using fixed appliances in both maxillary and mandibular arches, including supply of appliances, all adjustments of appliances, removal of appliances and retention (AO) | 2,122.60 |
| 75039 | Permanent dentition treatment — single arch (mandibular or maxillary) treatment (correction and alignment) using fixed appliances, including supply of appliances — initial 3 months of active treatment (AO) | 564.15 |
| 75042 | Permanent dentition treatment — single arch (mandibular or maxillary) treatment (correction and alignment) using fixed appliances, including supply of appliances — each 3 months of active treatment (including all adjustments and maintenance and removal of the appliances) after the first for a maximum of a further 33 months (AO) | 210.85 |
| 75045 | Permanent dentition treatment — 2 arch (mandibular and maxillary) treatment (correction and alignment) using fixed appliances, including supply of appliances — initial 3 months of active treatment (AO) | 1,129.35 |
| 75048 | Permanent dentition treatment — 2 arch (mandibular and maxillary) treatment (correction and alignment) using fixed appliances, including supply of appliances — each subsequent 3 months of active treatment (including all adjustments and maintenance, and removal of the appliances) after the first for a maximum of a further 33 months (AO) | 289.60 |
| 75049 | Retention, fixed or removable, single arch (mandibular or maxillary) — supply of retainer and supervision of retention (AO) | 338.95 |
| 75050 | Retention, fixed or removable, 2‑arch (mandibular and maxillary) — supply of retainers and supervision of retention (AO) | 654.35 |
| 75051 | Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances (AO) | 1,004.45 |
Part 2 of the Schedule (below the heading)
Repeal the table, substitute:
| Category 7 – Cleft Lip and Cleft Palate Services | |||
| Group C2 – Oral and Maxillofacial Services | |||
| Item | Service | Fee ($) | |
| 75150 | Initial professional attendance in a single course of treatment by an eligible oral and maxillofacial surgeon if the patient is referred to the surgeon by an eligible orthodontist (AOS) | 86.90 | |
| 75153 | Professional attendance by an eligible oral and maxillofacial surgeon after the first professional attendance by the surgeon in a single course of treatment if the patient is referred to the surgeon by an eligible orthodontist (AOS) | 43.70 | |
| 75156 | Production of dental study models (other than a service associated with a service to which item 75153 applies) before provision of a service: (a) to which item 52321, 53212 or 75618 applies; or (b) to which an item in the series 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 applies; in a single course of treatment, if the patient is referred by an eligible orthodontist (AOS) | 77.45 | |
| 75200 | Removal of tooth or tooth fragment (other than treatment to which item 75400, 75403, 75406, 75409, 75412 or 75415 applies), if the patient is referred by an eligible orthodontist (AD) | 55.80 | |
| 75203 | Removal of tooth or tooth fragment under general anaesthesia, if the patient is referred by an eligible orthodontist (AD) | 83.75 | |
| 75206 | Removal of each additional tooth or tooth fragment at the same attendance at which a service to which item 75200 or 75203 applies is rendered, if the patient is referred by an eligible orthodontist (AD) | 27.80 | |
| 75400 | Surgical removal of erupted tooth, if the patient is referred by an eligible orthodontist (AOS) | 167.40 | |
| 75403 | Surgical removal of tooth with soft tissue impaction, if the patient is referred by an eligible orthodontist (AOS) | 192.30 | |
| 75406 | Surgical removal of tooth with partial bone impaction, if the patient is referred by an eligible orthodontist (AOS) | 219.10 | |
| 75409 | Surgical removal of tooth with complete bone impaction, if the patient is referred by an eligible orthodontist (AOS) | 248.15 | |
| 75412 | Surgical removal of tooth fragment requiring incision of soft tissue only, if the patient is referred by an eligible orthodontist (AOS) | 138.60 | |
| 75415 | Surgical removal of tooth fragment requiring removal of bone, if the patient is referred by an eligible orthodontist (AOS) | 167.40 | |
| 75600 | Surgical exposure, stimulation and packing of unerupted tooth, if the patient is referred by an eligible orthodontist (AOS) | 235.75 | |
| 75603 | Surgical exposure of unerupted tooth for the purpose of fitting a traction device, if the patient is referred by an eligible orthodontist (AOS) | 277.10 | |
| 75606 | Surgical repositioning of unerupted tooth, if the patient is referred by an eligible orthodontist (AOS) | 277.10 | |
| 75609 | Transplantation of tooth bud, if the patient is referred by an eligible orthodontist (AOS) | 413.65 | |
| 75612 | Surgical procedure for intra oral implantation of osseointegrated fixture (first stage), if the patient is referred by an eligible orthodontist (AOS) | 511.90 | |
| 75615 | Surgical procedure for fixation of trans‑mucosal abutment (second stage of osseointegrated implant), if the patient is referred by an eligible orthodontist (AOS) | 189.50 | |
| 75618 | Provision and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome, if the patient is referred by an eligible orthodontist (AOS) | 235.30 | |
| 75621 | The provision and fitting of surgical template in conjunction with orthognathic surgical procedures in association with: (a) an item in the series: (i) 45720 to 45754; or (ii) 52342 to 52375; or (b) item 52380 or 52382; if the patient is referred by an eligible orthodontist (AOS) | 235.30 | |
Part 3 of the Schedule (below the heading)
Repeal the table, substitute:
| Category 7 – Cleft Lip and Cleft Palate Services | ||
| Group C3 – General and Prosthodontic Services | ||
| Item | Service | Fee ($) |
| 75800 | Attendance comprising consultation, preventive treatment and prophylaxis, of not less than 30 minutes in duration — each attendance to a maximum of 3 attendances in any period of 12 months (AD) | 83.75 |
| 75803 | Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD) | 335.05 |
| 75806 | Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD) | 392.95 |
| 75809 | Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD) | 465.30 |
| 75812 | Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD) | 517.00 |
| 75815 | Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD) | 630.85 |
| 75818 | Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD) | 744.40 |
| 75821 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD) | 599.60 |
| 75824 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD) | 692.70 |
| 75827 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD) | 796.30 |
| 75830 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD) | 878.95 |
| 75833 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD) | 1,075.30 |
| 75836 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD) | 1,230.45 |
| 75839 | Provision and fitting of retainers (other than treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) — each retainer (AD) | 27.80 |
| 75842 | Adjustment of partial denture (other than treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) (AD) | 41.40 |
| 75845 | Relining of partial denture by laboratory process and associated fitting (AD) | 206.90 |
| 75848 | Remodelling and fitting of partial denture of more than 4 teeth (AD) | 248.15 |
| 75851 | Repair to cast metal base of partial denture — 1 or more points (AD) | 124.10 |
| 75854 | Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD) | 124.10 |
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