My one caution is that if the scheme is withdrawn prior to completion of treatment, patients might be required to pay in full for the remainder of care.

Eligible patients

Patients must be managed under a GPMP & TCA, and “the patient’s oral health must also be impacting on, or likely to impact on, their general health” (MBS).

Entitlement

Eligible patients can receive up to $4,250 in Medicare benefits (including Extended Medicare Safety Net benefits where applicable) for dental services over two consecutive calendar years.

Patients will generally only be able to claim for one set of dentures every eight years under these Medicare items. However, patients may receive a second set within this period in exceptional circumstances.

Medicare pays for dental care via item numbers. As such it is important to notify patients that a gap payment might be required.

Eligible dental practitioners and referral

Dentists: EPC dental referral form

Prosthetist: GPs may refer eligible patients to a dentist (as above) who would then refer to a dental prosthetist. Where a patient has no natural teeth and requires dental prosthetic services only, a referral may be made to a dentist or dental prosthetist.

Dental Specialists: GPs are not permitted to refer directly to dental specialists. Where referral to another dental practitioner, dental specialist or dental prosthetist is necessary the dentist “may use a referral note or letter (signed and dated)” which must attach to a copy of the GP referral form “as the receiving dental practitioner will need the GP’s details and initial date of referral from the GP for Medicare billing” (Referral Form for Dental Services under Medicare).

MBS considers these to be dental specialists:

• Endodontist
• Orthodontist
• Oral and Maxillofacial Surgeon
• Periodontist
• Paedodontist (also known as Pedeodontist and Pedodontist)
• Prosthodontist
• Specialist in Oral Medicine and/or Oral Pathology
• Dento-maxillofacial Radiologist
• Oral Surgeon,
• Special Needs Dentist

Feedback requirements

Dental practitioners must provide a copy or summary of the patient’s treatment plan to the referring GP before beginning the course of treatment.

More

• DoHA information page on dental services under Medicare
• Printable fact sheet for GPs
• Printable fact sheet for dentists & dental specialists
• Printable fact sheet for dental prosthetists

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