| Dental items |
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Dental services under Medicare Medicare dental items (Medicare items 85011-87777) are available for people with chronic conditions and complex care needs, on referral from a GP. The patient's oral health must also be impacting on, or likely to impact on, their general health. Before a patient can access dental services under Medicare, the patient must have received the following services from a GP within the previous two years: · GP Management Plan (item 721 or a review under item 732) and Team Care Arrangements (item 723 or a review under item 732); or · For residents of an aged care facility, their GP must have contributed to or reviewed a multidisciplinary care plan prepared for the resident by the facility (item 731). The need for dental services should be recommended in the patient's care plan. GPs are encouraged to attach a copy of the relevant part of the patient's care plan when referring the patient to a dental practitioner. These services can be provided by dentists, dental specialists and dental prosthetists registered with Medicare Australia. Eligible patients can access up to $4,250 in Medicare benefits for dental services over two consecutive calendar years. The two-year period is counted from the calendar year of the patient's first eligible dental service. What types of dental services are covered The items cover a comprehensive range of dental services. These include dental assessments; removal of plaque and other preventive services; restorative services such as fillings, crowns, bridges and implants; extractions and other oral surgery (performed in a dentist's surgery); orthodontic services; and dentures. The dental items can only be used whether the primary objective of the treatment is to improve oral health and function. The items cannot be claimed for treatment that is predominantly for the improvement of the appearance of the patient (eg cosmetic). Services which aim to improve the health or function of the patient, but which also comprise a cosmetic component may be claimed. Referral by a GP to a dental practitioner If a person is eligible for dental services, a referral from a GP to a dental practitioner is required (see below). In most cases, the GP must refer the patient to an eligible dentist in the first instance. In some limited cases, the GP may refer the patient directly to a dental prosthetist. This can be done where the patient has no natural teeth and requires dental prosthetic services only (eg full dentures) or requires repairs or maintenance to full or partial dentures. Patients cannot be referred directly to a dental specialist by a GP. The dentist will decide whether a patient requires more specialised dental treatment, and where required, the dentist will make the necessary referral to a dental specialist. A dentist can also refer a patient to another dentist or a dental prosthetist if required. New referrals Where further dental services are required to treat a new or existing oral health problem at the end of a patient's two calendar year period, the patient will need to obtain a new referral from their GP. The patient's new two year period will be counted from the calendar year of the patient's first eligible dental service under the new referral. Fees: When referring patients for dental services, GPs should inform patients that the services will not necessarily be bulk billed. Dental practitioners are free to set their own fees for services and, in some instances, patients may incur out-of-pocket costs. To assist patients in understanding the cost of dental treatment, dental practitioners will be required to provide patients with a proposed treatment plan following an examination and assessment including any diagnostic tests. The plan must include an itemised quotation of proposed charges for future work. |
OUR SERVICES Medicare Support Dental items