Untitled document
Health Insurance (Cleft Lip and Cleft Palate Services) Determination 2012
as amended
made under subsection 3C(1) of the Health Insurance Act 1973
Compilation start date: 1 November 2013
Includes amendments up to: Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013
Prepared by the Department of Health, Canberra
About this compilation
The compiled instrument
This is a compilation of the Health Insurance (Cleft Lip and Cleft Palate Services) Determination 2012, amended and in force on 1 November 2013. It includes any amendment affecting the compiled instrument to that date.
This compilation was prepared on 2 November 2013.
The notes at the end of this compilation (the endnotes) include information about amending Acts and instruments and the amendment history of each amended provision.
Uncommenced provisions and amendments
If a provision of the compiled instrument is affected by an uncommenced amendment, the text of the uncommenced amendment is set out in the endnotes.
Application, saving and transitional provisions for amendments
If the operation of an amendment is affected by an application, saving or transitional provision, the provision is identified in the endnotes.
Modifications
If a provision of the compiled instrument is affected by a textual modification that is in force, the text of the modifying provision is set out in the endnotes.
Provisions ceasing to have effect
If a provision of the compiled instrument has expired or otherwise ceased to have effect in accordance with a provision of the instrument, details of the provision are set out in the endnotes.
Contents
Name of Determination 4
Commencement 4
4 Definitions 4
Treatment of relevant services 5
Limitation on services 5
Part 1Group C1 Orthodontic services and fees 7
Part 2Group C2 Oral and maxillofacial services and fees 9
Part 3Group C3 General and prosthodontic services and fees 11
Endnotes
1 Name of Determination
This Determination is the Health Insurance (Cleft Lip and Cleft Palate services) Determination 2012.
2 Commencement
This Determination will commence immediately following the commencement of the Health Insurance (General Medical Services Table) Amendment Regulations 2012 (No.4).
4 Definitions
In this Determination:
Act means the Health Insurance Act 1973.
dental practitioner means a practitioner registered under a law of a State or Territory in the division of dentist.
eligible oral and maxillofacial surgeon means a practitioner described in subsection 6(6) of this Determination.
eligible orthodontist means a dental practitioner described in subsection 6(2) of this Determination.
GMST Regulations 2011 means the Health Insurance (General Medical Services Table) Regulations 2011.
Note The Health Insurance (General Medical Services Table) Regulations 2011 commenced on 1 November 2011.
medical practitioner means a practitioner registered under a law of a State or Territory as a medical practitioner.
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 Schedule.
Schedule means the Schedule to this Determination.
Note Unless the contrary intention appears, expressions used in this Determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003. Terms defined in the Act include:
·general medical services table
·item
·professional service
(2) Unless the contrary intention appears, a reference in this Determination to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the NationalHealth 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 Treatment of relevant services
For subsection 3C (1) of the Act, a relevant service provided in accordance with this Determination 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 the Schedule in relation to the service.
Note For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.
6 Limitation on services
(1) Items 75001 to 75854 apply only to a service provided to a prescribed dental patient.
Note For the meaning of a prescribed dental patient, see section 3BA of the Act
(2) Subject to subsection (5), items 75001 to 75006 or 75024 to 75051 that include the symbol (AO) apply only to a service provided:
(a) by a dental practitioner who is registered under a law of a State or Territory in the specialty of orthodontics; or
(b) by a dental practitioner:
(i) who is not registered under a law of a State or Territory in the specialty of orthodontics; and
(ii) whose qualifications or experience demonstrate to the Australian Society of Orthodontists, prior to 31 March 2013, his or her competence in the field of orthodontics that is applicable to the giving of:
(A) services mentioned in items 75001 to 75006 or 75024 to 75051; or
(B) services mentioned in at least 1 of these items; or
(c) a dental practitioner who, immediately prior to this determination commencing, was an accredited orthodontist as defined in rule 2.59.2(3)(b) of the GMST Regulations 2011 or any equivalent provision of preceding regulations.
(3) Subject to subsection (5), items 75009 to 75023 that include the symbol (AO) and the symbol (AOS) apply only to a service provided by:
(a) a dental practitioner who is registered under a law of a State or Territory in the specialty of orthodontics; or
(b) a dental practitioner:
(i) who is not registered under a law of a State or Territory in the specialty of orthodontics; and
(ii) whose qualifications or experience demonstrate to the Australian Society of Orthodontists, prior to 31 March 2013, his or her competence in the field of orthodontics that is applicable to the giving of:
(A) services mentioned in items 75009 to 75023; or
(B) services mentioned in at least 1 of these items;
(c) a medical practitioner who is a specialist in the practice of his or her specialty of oral and maxillofacial surgery; or
(d) a dental practitioner who, immediately prior to this determination commencing, was an accredited orthodontist as defined in rule 2.59.2(3)(b) of the GMST Regulations 2011 or any equivalent provision of preceding regulations; or
(e) a dental practitioner who, immediately prior to this determination commencing, held an approval granted by the Minister for the purposes of the definition of professional service in subsection 3(1) of the Act.
(4) 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 GMST Regulations 2011, 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.
(5) If a service described in an item mentioned in subsection (2) or (3) is performed by a dental practitioner described in paragraph (2)(b), (2)(c), (3)(b) or (3)(d), the item for the service applies only if the dental practitioner’s experience or qualifications demonstrated his or her competence in the field of orthodontics applicable to the giving of the service mentioned in that item.
(6) Items 75150 to 75156 or 75400 to 75621 that include the symbol (AOS) apply only to a service provided by:
(a) a medical practitioner who is a specialist in the practice of his or her specialty of oral and maxillofacial surgery; or
(b) a dental practitioner who, immediately prior to this determination commencing, held an approval granted by the Minister for the purposes of the definition of professional service in subsection 3(1) of the Act.
(7) Items 75200 to 75206 or 75800 to 75854 that include the symbol (AD) apply only to a service provided by a dental practitioner
Schedule Specified health services
Part 1 Group C1 Orthodontic services and fees
| Item | Service | Fee for all States ($) | |
| 75001 | Initial professional attendance in a single course of treatment by an eligible orthodontist (AO) | 85.55 | |
| 75004 | Professional attendance by an eligible orthodontist after the first professional attendance by the orthodontist in a single course of treatment (AO) | 43.00 | |
| 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) | 76.25 | |
| 75009 | Orthodontic radiography — orthopantomography (panoramic radiography), including any consultation on the same occasion (AOS) (AO) | 68.15 | |
| 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) | 108.05 | |
| 75015 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings including any consultation on the same occasion (AOS) (AO) | 148.55 | |
| 75018 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography including any consultation on the same occasion (AOS) (AO) | 189.25 | |
| 75021 | Orthodontic radiography — hand‑wrist studies (including growth prediction) including any consultation on the same occasion (AOS) (AO) | 232.05 | |
| 75023 | Intraoral radiography — single area, periapical or bitewing film (AOS) (AO) | 46.45 | |
| 75024 | Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 1 appliance is used (AO) | 600.10 | |
| 75027 | Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 2 appliances are used (AO) | 822.90 | |
| 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) | 732.70 | |
| 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) | 1,200.95 | |
| 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) | 611.25 | |
| 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) | 1,658.75 | |
| 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) | 2,089.15 | |
| 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) | 555.25 | |
| 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) | 207.55 | |
| 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) | 1,111.55 | |
| 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) | 285.05 | |
| 75049 | Retention, fixed or removable, single arch (mandibular or maxillary) — supply of retainer and supervision of retention (AO) | 333.60 | |
| 75050 | Retention, fixed or removable, 2‑arch (mandibular and maxillary) — supply of retainers and supervision of retention (AO) | 644.05 | |
| 75051 | Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances (AO) | 988.65 | |
Part 2 Group C2 Oral and maxillofacial services and fees
| Item | Service | Fee for all States ($) |
| 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) | 85.55 |
| 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) | 43.00 |
| 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) | 76.25 |
| 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) | 54.90 |
| 75203 | Removal of tooth or tooth fragment under general anaesthesia, if the patient is referred by an eligible orthodontist (AD) | 82.45 |
| 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) | 27.35 |
| 75400 | Surgical removal of erupted tooth, if the patient is referred by an eligible orthodontist (AOS) | 164.75 |
| 75403 | Surgical removal of tooth with soft tissue impaction, if the patient is referred by an eligible orthodontist (AOS) | 189.25 |
| 75406 | Surgical removal of tooth with partial bone impaction, if the patient is referred by an eligible orthodontist (AOS) | 215.65 |
| 75409 | Surgical removal of tooth with complete bone impaction, if the patient is referred by an eligible orthodontist (AOS) | 244.25 |
| 75412 | Surgical removal of tooth fragment requiring incision of soft tissue only, if the patient is referred by an eligible orthodontist (AOS) | 136.40 |
| 75415 | Surgical removal of tooth fragment requiring removal of bone, if the patient is referred by an eligible orthodontist (AOS) | 164.75 |
| 75600 | Surgical exposure, stimulation and packing of unerupted tooth, if the patient is referred by an eligible orthodontist (AOS) | 232.05 |
| 75603 | Surgical exposure of unerupted tooth for the purpose of fitting a traction device, if the patient is referred by an eligible orthodontist (AOS) | 272.75 |
| 75606 | Surgical repositioning of unerupted tooth, if the patient is referred by an eligible orthodontist (AOS) | 272.75 |
| 75609 | Transplantation of tooth bud, if the patient is referred by an eligible orthodontist (AOS) | 409.15 |
| 75612 | Surgical procedure for intra oral implantation of osseointegrated fixture (first stage), if the patient is referred by an eligible orthodontist (AOS) | 503.85 |
| 75615 | Surgical procedure for fixation of trans‑mucosal abutment (second stage of osseointegrated implant), if the patient is referred by an eligible orthodontist (AOS) | 186.50 |
| 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) | 231.60 |
| 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) | 231.60 |
Part 3 Group C3 General and prosthodontic services and fees
| Item | Service | Fee for all States ($) |
| 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) | 82.45 |
| 75803 | Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD) | 329.75 |
| 75806 | Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD) | 386.75 |
| 75809 | Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD) | 457.95 |
| 75812 | Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD) | 508.85 |
| 75815 | Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD) | 620.90 |
| 75818 | Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD) | 732.70 |
| 75821 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD) | 590.15 |
| 75824 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD) | 681.80 |
| 75827 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD) | 783.75 |
| 75830 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD) | 865.10 |
| 75833 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD) | 1,058.35 |
| 75836 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD) | 1,211.05 |
| 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) | 27.35 |
| 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) | 40.75 |
| 75845 | Relining of partial denture by laboratory process and associated fitting (AD) | 203.65 |
| 75848 | Remodelling and fitting of partial denture of more than 4 teeth (AD) | 244.25 |
| 75851 | Repair to cast metal base of partial denture — 1 or more points (AD) | 122.15 |
| 75854 | Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD) | 122.15 |
Note
1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See 1—About the endnotes
The endnotes provide details of the history of this compilation and its provisions. The following endnotes are included in each compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Endnote 5—Uncommenced amendments
Endnote 6—Modifications
Endnote 7—Misdescribed amendments
Endnote 8—Miscellaneous
If there is no information under a particular endnote, the word “none” will appear in square brackets after the endnote heading.
Abbreviation key—Endnote 2
The abbreviation key in this endnote sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended the compiled law. The information includes commencement information for amending laws and details of application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision level. It also includes information about any provisions that have expired or otherwise ceased to have effect in accordance with a provision of the compiled law.
Uncommenced amendments—Endnote 5
The effect of uncommenced amendments is not reflected in the text of the compiled law, but the text of the amendments is included in endnote 5.
Modifications—Endnote 6
If the compiled law is affected by a modification that is in force, details of the modification are included in endnote 6.
Misdescribed amendments—Endnote 7
An amendment is a misdescribed amendment if the effect of the amendment cannot be incorporated into the text of the compilation. Any misdescribed amendment is included in endnote 7.
Miscellaneous—Endnote 8
Endnote 8 includes any additional information that may be helpful for a reader of the compilation.
Endnote 2—Abbreviation key
| ad = added or inserted | pres = present |
| am = amended | prev = previous |
| c = clause(s) | (prev) = previously |
| Ch = Chapter(s) | Pt = Part(s) |
| def = definition(s) | r = regulation(s)/rule(s) |
| Dict = Dictionary | Reg = Regulation/Regulations |
| disallowed = disallowed by Parliament | reloc = relocated |
| Div = Division(s) | renum = renumbered |
| exp = expired or ceased to have effect | rep = repealed |
| hdg = heading(s) | rs = repealed and substituted |
| LI = Legislative Instrument | s = section(s) |
| LIA = Legislative Instruments Act 2003 | Sch = Schedule(s) |
| mod = modified/modification | Sdiv = Subdivision(s) |
| No = Number(s) | SLI = Select Legislative Instrument |
| o = order(s) | SR = Statutory Rules |
| Ord = Ordinance | Sub‑Ch = Sub‑Chapter(s) |
| orig = original | SubPt = Subpart(s) |
| par = paragraph(s)/subparagraph(s) | |
| /sub‑subparagraph(s) |
Endnote 3 – Legislation History
Table of Instruments
| Title | FRLI registration date | Commencement date | Application, saving and |
| Health Insurance (Cleft Lip and Cleft Palate Services) Determination 2012 | 31 Oct 2013 (see F2012L02113) | 1 Nov 2012 | |
| Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013 | 23 Oct 2013 (see F2013L01825) | 1 Nov 2013 | — |
Endnote 4 – Amendment history
| ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted exp. = expired or ceased to have effect | |
| Provision affected | How affected |
| Determination | |
| S. 3......................................... | rep. F2013L01825 |
Endnote 5—Uncommenced amendments [none]
Endnote 6—Modifications [none]
Endnote 7—Misdescribed amendments [none]
Endnote 8—Miscellaneous [none]
0
0
0