|
Existing MBS dental items (10975-10977) |
New MBS dental items (85011-87777) |
Patient eligibility |
Patients with a chronic condition and complex care
needs whose dental condition is exacerbating their chronic medical
condition, on referral from their GP under an EPC plan. That is, a
patient must have in place:
- a GP Management Plan (GPMP) – item 721 (or a GPMP
review item 725) AND
- a Team Care Arrangements (TCA) – item 723 (or a TCA
review item 727)
OR
- for a resident of a residential
aged care facility, the GP must have contributed to, or reviewed, a care plan
prepared by an aged care facility (item 731).
|
Patients with a chronic condition and complex care
needs whose oral health is impacting on, or is likely to impact on, their
general health, on referral from their GP under an EPC plan. That is, a
patient must have in place:
- a GP Management Plan (GPMP) – item 721 (or a GPMP
review item 725) AND
- a Team Care Arrangements (TCA) – item 723 (or a TCA
review item 727)
OR
- for a resident of a residential
aged care facility, the GP must have contributed to, or reviewed, a care plan
prepared by an aged care facility (item 731)
|
Eligible providers |
Dentists and dental specialists |
Dentists, dental specialists and dental prosthetists |
Referral process |
GP must refer the patient to a dentist.
Patients cannot be referred directly to a dental
specialist (referred on by the dentist).
GP must use an EPC Program Referral Form for
Dental Care under Medicare or a form that substantially complies with the
form issued by the Department.
Patients need a new referral form when they have had
all 3 services available each calendar year (referrals may cross calendar
years). |
In most cases, GP must refer the patient to a
dentist. However, where the patient has no natural teeth and requires dental
prosthetic services only (eg full dentures), or requires repairs or
maintenance to an existing denture/s the GP may refer the patient to either a
dentist or dental prosthetist.
Patients cannot be referred directly to a dental
specialist (referred on by the dentist).
GP must use the referral form provided by the
Department of Health and Ageing or a form that substantially complies with
the form issued by the Department.
|
Medicare rebate |
Currently $77.95 per service (to be indexed on
1 November 2007).
Out-of-pocket costs for eligible services count
towards Medicare Safety Nets. |
There is no single rebate. The rebate will vary from
item to item. Rebates for individual items to be set out in a new MBS dental
schedule.
Out-of-pocket costs for eligible services count
towards Medicare Safety Nets up to the limit of $4,250 over two consecutive
calendar years. |
Limits on services |
3 services per patient, per calendar year.
Total annual benefits = $233.85 + Safety Net benefits
(where applicable).
Patients must have a dental assessment by a dentist
(item 10975) as their first service, then a dental assessment every year they
are referred by a GP. |
Up to a maximum of $4,250 in dental benefits (including Medicare Safety Net benefits where applicable)
per patient every two consecutive calendar years.
No limit on total number of services. However, some
limits on specific services will apply as per DVA arrangements (eg limit of 1
oral hygiene instruction service per 12 months).
No mandatory requirement that a patient has a dental
assessment. Access to services based on clinical needs. |
Dental Prostheses
(eg dentures) |
The cost of supplying dental prostheses is not
covered by Medicare. However, the cost of fitting prostheses can be included
under 10976 or 10977. |
The cost of supplying and fitting dental prostheses
can be included under the relevant new dental items. |