{"id":"F2024L00110","name":"Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024","slug":"health-insurance-section-3c-general-medical-services-cleft-and-craniofacial-services-determination-2","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":105069,"registerId":"commonwealth-F2024L00110-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\n This instrument is the Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024.","sortOrder":0},{"sectionNumber":"3","sectionType":"section","heading":"Authority","content":"#### 3 Authority\n\n This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":1},{"sectionNumber":"4","sectionType":"section","heading":"Definitions","content":"#### 4 Definitions\n\n(1) In this instrument:\n\nAct means the Health Insurance Act 1973.\n\ndental practitioner has the same meaning as subsection 3(1) of the Act.\n\neligible oral and maxillofacial surgeon means a dental practitioner who is recognised under the National Law in the speciality of oral and maxillofacial surgery.\n\neligible orthodontist means:\n\n(a) a dental practitioner who is registered under National Law in the speciality of orthodontics; or\n\n(b) a dental practitioner whose qualifications or experience were recognised by the Australian Society of Orthodontists, prior to 31 March 2013, as applicable to:\n\ni. services mentioned in items 75002, 75005, 75007, 75012, 75015, and 75024 to 75051; or\n\nii. services mentioned in at least one of these items; or\n\n(c) a dental practitioner who, immediately prior to 1 November 2012, was a registered orthodontist as defined in rule 2.59.2(3)(b) of the general medical services table or any equivalent provision of preceding regulations.\n\nNote: 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 general medical services table, 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.\n\neligible paediatric dentist means a dental practitioner who is recognised under the National Law in the speciality of paediatric dentistry.\n\neligible prosthodontist means a dental practitioner who is recognised under the National Law in the speciality of prosthodontics.\n\nmedical practitioner has the same meaning as subsection 3(1) of the Act.\n\nreferring dentist means a dental practitioner who is recognised under the National Law in the dentists division of the dental profession.\n\nrelevant 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.\n\nrelevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the table at Schedule 2.\n\nSchedule means a Schedule to this instrument.\n\nNote: Unless the contrary intention appears, expressions used in this instrument have the same meanings as in the Act—see section 13 of the Legislation Act 2003. Terms defined in the Act include:\n\n general medical services table\n\n item\n\n National Law\n\n professional service\n\n(2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health 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.","sortOrder":2},{"sectionNumber":"5","sectionType":"section","heading":"Schedules","content":"#### 5 Schedules\n\n Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.","sortOrder":3},{"sectionNumber":"6","sectionType":"section","heading":"Relevant services","content":"#### 6 Relevant services\n\nFor subsection 3C(1) of the Act, a relevant service provided in accordance with this instrument is to be treated, for the relevant provisions, as if:\n\n (a) it were both a professional service and a medical service; and\n (b) there were an item in the general medical services table that:\n (i) related to the service; and\n (ii) specified for the service a fee in relation to each State, being the fee specified in Schedule 1 in relation to the service.","sortOrder":4},{"sectionNumber":"7","sectionType":"section","heading":"Limitation on services","content":"#### 7 Limitation on services\n\n(1) An item specified in Schedule 1 to this Determination only applies to a service provided to a patient with an eligible cleft or craniofacial condition, as specified in the table at Schedule 2.\n\n(2) Items 75009, 75010, 75011,75023, 75200, 75203, 75206, 75400, 75402, 75800, 75802, 75815, 75818, 75820, 75833, 75836, 75842, 75845, 75848, 75851 and 75854 apply to a service provided by a dental practitioner.\n\n(3) Items 75002, 75005, 75007, 75012, 75015, 75024, 75027, 75030, 75032, 75034, 75039, 75042, 75045, 75048, 75049, 75050, 75051, 75618 and 75621 apply to a service provided by an eligible orthodontist.\n\n(4) Items 75002, 75005, 75007, 75618 and 75621 apply to a service provided by an eligible prosthodontist.\n\n(5) Items 75002, 75005, 75007, 75024, 75027, 75600 and 75603 apply to a service provided by an eligible paediatric dentist.\n\n(6) Items 75002, 75005, 75007, 75012, 75015, 75405, 75600, 75603, 75606, 75609, 75610, 75618 and 75621 apply to a service provided by:\n\n (a) an eligible oral and maxillofacial surgeon; or\n (b) a dental practitioner who, immediately prior to 1 November 2012, held an approval granted by the Minister for the purposes of the definition of professional service in subsection 3(1) of the Act.","sortOrder":5},{"sectionNumber":"8","sectionType":"section","heading":"Requirement for referral by a referring dentist or medical practitioner","content":"#### 8 Requirement for referral by a referring dentist or medical practitioner\n\n(1) Items 75002, 75005, 75200, 75203, 75206, 75400, 75402, 75600, 75603, 75618 and 75621 apply only to a service provided by an eligible oral and maxillofacial surgeon if the patient has been referred by a referring dentist or medical practitioner.","sortOrder":6},{"sectionNumber":"9","sectionType":"section","heading":"Indexation","content":"#### 9 Indexation\n\n(1) At the start of 1 July 2025 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:\n\n![1.024 multiplied by the amount immediately before the indexation time](image.002.png)\n\n Note: The indexed fees could in 2025 be viewed on the Department of Health and Aged Care’s MBS Online website (https://www.mbsonline.gov.au).\n\n(2) The amounts covered by this subsection are the fee for each item in Schedule 1 of this Determination.\n\n(3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).\n\nSchedule 1—Specified health services \n\n```html\n

Group C1­—Cleft and Craniofacial Services

Item

Service

Fee ($)

75002

Initial professional attendance, in a single course of treatment (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies)

94.10

75005

Subsequent professional attendance in a single course of treatment (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies)

47.35

75007

Production of dental study models (other than a service associated with a service to which item 75002 or 75005 applies) prior to provision of a service to which:

(a) item 75030, 75032, 75039, 75045 or 75051 apply; or

(b) an item in Group T8 or Groups O3 to O9 apply; or

(c) item 52321, 53212 or 75618 apply; or

(d) any of items 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 apply;

in a single treatment

83.85

75009

Orthodontic radiography—orthopantomography (panoramic radiography), including any consultation on the same occasion

75.05

75010

Orthodontic radiography – anteroposterior or lateral cephalometric radiography, with cephalometric tracings, and orthopantomography, including any consultation on the same occasion

151.80

75011

Orthodontic radiography – anteroposterior and lateral cephalometric radiography, with cephalometric tracings, and orthopantomography, including any consultation on the same occasion

197.90

75012

Orthodontic anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion

118.95

75015

Radiography anteroposterior and lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion

163.50

75023

Intraoral radiography—single area, periapical or bitewing film

51.10

75024

Pre‑surgical infant maxillary arch repositioning including nasoalveolar moulding, supply of appliances and all adjustments of appliances, and supervision of all components of the service—if 1 appliance is used

660.55

75027

Pre‑surgical infant maxillary arch repositioning including nasoalveolar moulding, supply of appliances and all adjustments of appliances, and supervision of all components of the service—if 2 appliances are used

905.75

75030

Maxillary arch expansion (other than a service associated with a service to which item 75039, 75042, 75045 or 75048 applies), including supply of appliances and all adjustments of appliances, removal of appliances and retention

806.45

75032

Mixed dentition treatment including incisor alignment (mandibular and/or maxillary) lateral arch expansion, including supply of appliances and all adjustments of appliances, removal of appliances and retention

1815.80

75034

Mixed dentition treatment—incisor alignment with or without lateral arch expansion using a removable appliance in the maxillary arch, including supply of all appliances, and associated adjustments and retention

672.80

75039

Permanent dentition treatment—single arch (mandibular or maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances and aligners—initial 3 months of active treatment

611.20

75042

Permanent dentition treatment—single arch (mandibular or maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances and aligners—each subsequent 3 months of active treatment (including all adjustments and maintenance and removal of the appliances) after the initial three months of active treatment for a maximum of a further 33 months

228.45

75045

Permanent dentition treatment—2 arch (mandibular and maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances or aligners—initial 3 months of active treatment

1,223.50

75048

Permanent dentition treatment—2 arch (mandibular and maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances or aligners—each subsequent 3 months of active treatment (including all adjustments and maintenance, and removal of the appliances) after the initial three months of active treatment for a maximum of a further 33 months

313.75

75049

Retention, fixed or removable, single arch (mandibular or maxillary)—supply of retainer and supervision of retention

367.25

75050

Retention, fixed or removable, 2‑arch (mandibular and maxillary)—supply of retainers and supervision of retention

708.90

75051

Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances

1,088.20

75200

Removal of tooth or tooth fragment (other than treatment to which item 75402 or 75405 applies)

60.45

75203

Removal of tooth or tooth fragment under general anaesthesia (H)

90.70

75206

Removal of each additional tooth or tooth fragment if provided in association with a service to which item 75200 or 75203 applies

30.10

75400

Surgical removal of erupted tooth

181.35

75402

Surgical removal of tooth, or tooth fragment requiring incision of soft tissue only

179.25

75405

Surgical removal of tooth, or tooth fragment requiring removal of bone, where the patient is referred by a referring dentist or medical practitioner

229.20

75600

Surgical exposure and packing of unerupted tooth

255.40

75603

Surgical exposure of unerupted tooth for the purpose of fitting a traction device or placement of a temporary anchorage device

300.25

75606

Surgical repositioning of unerupted tooth where the patient is referred by a referring dentist or medical practitioner

300.25

75609

Transplantation of tooth bud where the patient is referred by a referring dentist or medical practitioner

448.20

75610

Surgical procedure for intraoral implantation of an osseointegrated fixture and placement of transmucosal abutments where the patient is referred by a referring dentist or medical practitioner (H)

380.00

75618

Fabrication and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome

254.90

75621

The fabrication and fitting of surgical splint or guide in conjunction with orthognathic surgical procedures and implant treatment, if provided in association with a service to which:

(a) any item in the following series applies:

(i) any of items 46150 to 46161 apply; or

(ii) any of items 52342 to 52375 apply; or

(b) item 52380 or 52382 applies;

(c) item 75610 applies

254.90

75800

Attendance involving consultation, preventive treatment and prophylaxis, of not less than 30 minutes in duration for each attendance to a maximum of 3 attendances in any 12 month period (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies)

90.70

75802

Fabrication and fitting of acrylic base partial denture, including retainers—1 to 4 teeth

463.20

75815

Fabrication and fitting of acrylic base partial denture, including retainers—5 to 9 teeth

683.45

75818

Fabrication and fitting of acrylic base partial denture or complete denture or overdenture, including retainers—10 to 12 teeth

806.45

75820

Fabrication and fitting of metal framework partial denture, including all components—1 to 4 teeth

803.80

75833

Fabrication and fitting of metal framework partial denture including all components—5 to 9 teeth

1,164.95

75836

Fabrication and fitting of metal framework partial denture or complete denture or overdenture including all components—10 to 12 teeth

1,333.05

75842

Adjustment of denture (other than a service associated with a service to which item 75802, 75815, 75818, 75820, 75833 or 75836 applies)

44.85

75845

Relining of denture by laboratory process and associated fitting

224.15

75848

Remodelling and fitting of denture of more than 4 teeth

268.80

75851

Repair to metal framework of denture—1 or more points

134.45

75854

Addition of a tooth or teeth to a denture to replace extracted tooth or teeth, including taking of necessary impression

134.45

\n```\n\nSchedule 2—Eligible cleft or craniofacial conditions \n\n```html\n

Table 9– Eligible cleft or craniofacial conditions

1. Oral and/or facial clefting

Limited to

Cleft lip, alveolus and/or palate

Tessier facial cleft

2. Congenital or hereditary craniofacial malformation, deformation or disruption

Limited to

Achondroplasia

Branchial arch disorders including:

Hemifacial/craniofacial microsomia, Goldenhar syndrome, DiGeorge syndrome, Velocardiofacial syndrome, Auriculo‑condylar syndrome

CHARGE syndrome

Congenital hemifacial hyperplasia

Congenital lymphatic and/or vascular malformations of the head & neck, cystic hygroma, Sturge‑Weber syndrome, excluding haemangiomas, birthmarks, and naevi.

Craniofacial Neurofibromatosis Type 1

Craniometaphyseal dysplasia

Congenital lymphatic and vascular malformations and segmental haemangiomas involving the jaws and associated soft tissues including cystic hygroma and Sturge‑Weber syndrome.

Ectodermal dysplasia

Hemifacial atrophy (Parry Romberg syndrome)

Mandibulofacial dysostosis (Treacher Collins syndrome)

Maxillonasal dysplasia (Binder syndrome)

Oral‑facial digital syndrome Type 1

Osteogenesis imperfercta

Pierre Robin sequence

Rubinstein‑Taybi syndrome

Shprintzen‑Goldberg syndrome

Solitary median maxillary central incisor syndrome

Stickler syndrome

Syndromic craniosynostoses including:

Apert, Crouzon, Pfeiffer, Saethre Chotzen, and Muenke syndromes

Trichorhinophalangeal syndrome Type 1

3. Hereditary conditions presenting with the absence of 6 (six) or more permanent teeth, excluding 3rd molars

4. Hereditary conditions where the presence of supernumerary teeth is a major feature

Limited to

Cleidocranial dysplasia

Gardner’s syndrome

5. Development or Hereditary conditions affecting the formation of enamel and/or dentine of all teeth

Limited to

Amelogenesis imperfecta

Dentinogenesis imperfecta

Regional odontodysplasia

\n```","sortOrder":7}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"This Determination implements a focused expansion of Medicare‑recognised services by formally specifying which cleft and craniofacial services are to be treated as professional and medical services and by setting the fees and eligibility rules for those services. It stays within the original statutory mechanism in subsection 3C(1) (i.e. specifying items and fees) rather than broadening the Act’s substantive reach. The instrument does add detailed eligibility, provider definitions (including historical recognition), and a scheduled indexation step, but these are administrative and definitional refinements rather than a material scope expansion beyond the Determination’s evident purpose."},"complexity_factors":["Two Schedules with detailed tables: Schedule 1 (around 70 fee items across multiple dental/medical item numbers) and Schedule 2 (a multi‑row list of eligible cleft/craniofacial conditions).","Multiple defined terms in section 4 with nested sub‑clauses (e.g. eligible orthodontist has three alternative paths to eligibility, including historical recognition clauses).","Numerous cross‑references to external instruments and concepts: Health Insurance Act 1973, National Health Act 1953, National Law, and the general medical services table (section 4 and notes).","Conditional allocation of item numbers to particular provider types (section 7(2)–(6)) and separate referral conditions (section 8) creating branching claim‑eligibility rules.","Exceptions and exceptions‑to‑exceptions in Schedule 1 text (e.g. items excluded when associated with other specified items; multi‑part service descriptions with qualifying phrases).","Indexation rule that modifies every Schedule 1 fee at a future date (section 9), including a precise multiplier and rounding rule — a temporal change in amounts to monitor administratively.","Preservation of historical approvals and grandfathered arrangements (section 4(b)(ii) and 7(6)(b)) which require checking older records and make eligibility verification more complex.","Interplay between diagnostic eligibility (Schedule 2) and the wide array of procedure items — requires clinicians/administrators to match condition to permissible items for each claim."],"plain_english_summary":"**What this instrument does (mechanically)\n\n- Creates a statutory determination under subsection 3C(1) of the Health Insurance Act 1973 that treats a set of cleft and craniofacial health services as being both \"professional services\" and \"medical services\" for the purposes of the Act (see section 6). That means the Commonwealth will recognise these services for Health Insurance (Medicare) billing under specified item numbers.\n- Lists the specific services and the Medicare-style fee for each service in Schedule 1 (Group C1 — Cleft and Craniofacial Services). The fees are state‑specific in concept but Schedule 1 contains the monetary amounts to be used (section 6(b)).\n- Limits eligibility so the listed items can only be claimed when the patient has one of the eligible cleft or craniofacial conditions set out in Schedule 2 (section 7(1)).\n- Defines which provider types may use which item numbers (section 7(2)–(6)). Some items are limited to dental practitioners generally, others to specifically defined \"eligible\" orthodontists, prosthodontists, paediatric dentists or oral & maxillofacial surgeons (definitions in section 4 and application in section 7).\n- Requires that certain items provided by oral & maxillofacial surgeons are only payable where the patient was referred by a referring dentist or a medical practitioner (section 8).\n- Applies an automatic indexation (increase) to every fee in Schedule 1 at 1 July 2025 using a multiplier of 1.024 (a 2.4% increase), with rounding rules to the nearest 5 cents (section 9).\n\n**Who this affects\n\n- Patients: People with one of the specific cleft or craniofacial conditions listed in Schedule 2. Only services for those eligible diagnoses may be claimed under these items.\n- Providers: Certain dental and medical specialists. The instrument distinguishes between: general dental practitioners, \"eligible\" oral & maxillofacial surgeons, \"eligible\" orthodontists, \"eligible\" paediatric dentists and \"eligible\" prosthodontists (section 4 and section 7). Some items require referral (section 8). Older practitioners with historical recognition/approvals are explicitly preserved in certain cases (section 4(b)(ii) and 7(6)(b)).\n- The Commonwealth (Medicare): the instrument determines which services the Commonwealth will treat as payable professional/medical services and at what fee.\n\n**Why it matters (practical legal effects)\n\n- It makes a defined package of cleft and craniofacial procedures billable under the Health Insurance legislation using particular item numbers and fees (section 6 and Schedule 1). That creates an entitlement pathway for providers to submit claims to Medicare for the listed services when the patient and provider meet the eligibility rules.\n- It constrains claims to specified clinical indications (Schedule 2) and specified provider categories (sections 4 and 7), imposing clinical and occupational gatekeeping for access to Medicare payments.\n- It sets a mechanical, time‑triggered fee increase (indexation) to take effect 1 July 2025 (section 9).\n\n**Official purpose-claims and testing them against costs, incentives and implementation risks\n\n- Claimed purpose (implicit in design): to recognise and fund a defined set of cleft and craniofacial services under Health Insurance, with clear provider and diagnostic eligibility, so those services can attract Medicare rebates.\n\n- Who pays and where cost sits: once providers bill under these items, Medicare (the Commonwealth) meets the scheduled rebate portion. The instrument therefore creates a fiscal cost to the Commonwealth proportional to utilisation of the listed items (section 6 and Schedule 1). The instrument does not itself set patient co‑payment rules — those follow the usual Medicare arrangements (the Act and general medical services table provisions referenced in section 4).\n\n- Incentives and behaviour changes created:\n - Providers who meet the \"eligible\" definitions are enabled to bill these item numbers; that may encourage delivery of these services within the Medicare billing framework (sections 4, 7).\n - Referral requirements (section 8) introduce a gatekeeping step: oral & maxillofacial surgeon claims for particular items require prior referral by a dentist or medical practitioner, which shapes referral pathways and may affect where care is delivered.\n - Historical recognition clauses (section 4(b) and 7(6)(b)) preserve billing ability for practitioners with older accreditation arrangements, reducing disruptive effects on incumbents.\n\n- Compliance and administrative burdens:\n - Providers must ensure the patient’s condition is one of those listed in Schedule 2 before using these items (section 7(1)).\n - Providers must meet the particular registration/recognition requirements in the definitions (section 4) and satisfy referral conditions where applicable (section 8). Those are administrative checks for clinics, hospitals and Medicare claims processing.\n\n- Trade‑offs and opportunity costs:\n - Funds used to reimburse these specific items are not available for other items. The instrument locks in a defined fee schedule for these services and a fixed indexation step, creating predictable recurring costs for the Commonwealth once utilisation occurs (Schedule 1; section 9).\n\n- Implementation risk and potential frictions:\n - Correctly matching clinical diagnosis to Schedule 2 eligibility will require consistent clinical coding/recordkeeping; disputes or auditing may arise if a clinician records a condition not clearly on the Schedule.\n - Verifying provider eligibility (e.g. historical recognition) may require cross‑checking registration history or ministerial approvals.\n\n**Concrete mechanisms that could concentrate benefits or change provision patterns (source‑grounded)\n\n- Concentrated beneficiaries: the listed specialist groups (orthodontists, oral & maxillofacial surgeons, paediatric dentists, prosthodontists) are the direct claimants of the new schedule (sections 4 and 7). They stand to receive the fee reimbursements when providing covered services.\n- Gatekeeping/substitution effects: referral requirements and condition limits (sections 7 and 8; Schedule 2) steer patients into defined clinical pathways and may limit use of these items for other facial/dental conditions.\n\n**Key statutory references in the instrument**\n- Definitions and provider eligibility: section 4\n- Effect of the Determination treating services as professional and medical services and specifying fees: section 6\n- Limits on which items apply to which patients/providers: section 7 (and Schedule 1 and Schedule 2)\n- Referral requirement for certain items: section 8\n- Fee indexation (1 July 2025): section 9\n\n(End of summary.)"},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This appears to be a standard annual/periodic update to the cleft and craniofacial services determination. The scope remains tightly focused on its original purpose: providing Medicare rebates for specialised dental treatment of congenital craniofacial conditions. The inclusion of modern treatment modalities (clear aligners alongside traditional braces) and updated indexation provisions represent normal evolution rather than scope creep."},"complexity_factors":["Multiple overlapping practitioner eligibility rules with grandfathering provisions dating back to 2012 and 2013","47 distinct service items with specific fee amounts","Complex cross-referencing between items (e.g., item 75007 excludes services associated with items 75002/75005, but includes services linked to 14 other item ranges)","Nested conditions for service provision—some items restricted by patient condition, practitioner type, AND referral requirements simultaneously","Extensive defined terms (9 explicit definitions plus inherited definitions from parent Act)","Schedule 2 contains 5 categories of eligible conditions with 25+ specific named syndromes and disorders","Mathematical indexation formula with rounding rules to nearest 5 cents","External references to National Law, MBS Online website, and preceding regulations"],"plain_english_summary":"This instrument establishes Medicare rebates for specialised dental and orthodontic care for people born with cleft lip/palate and other listed craniofacial conditions. It defines which services qualify, sets the government fees, names eligible providers, requires certain referrals, and schedules a fee increase in July 2025.\n\nIt affects patients with specified congenital disorders and the dental specialists who treat them — ensuring these complex, often lifelong treatments attract Medicare support and reduce otherwise substantial out‑of‑pocket costs."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-general-medical-services-cleft-and-craniofacial-services-determination-2","history":"/api/acts/health-insurance-section-3c-general-medical-services-cleft-and-craniofacial-services-determination-2/history","analysis":"/api/acts/health-insurance-section-3c-general-medical-services-cleft-and-craniofacial-services-determination-2/analysis","conflicts":"/api/acts/health-insurance-section-3c-general-medical-services-cleft-and-craniofacial-services-determination-2/conflicts","importantCases":"/api/acts/health-insurance-section-3c-general-medical-services-cleft-and-craniofacial-services-determination-2/important-cases","documents":"/api/acts/health-insurance-section-3c-general-medical-services-cleft-and-craniofacial-services-determination-2/documents"}}