Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024
In ForceCTH
Jurisdiction
Commonwealth
Collection
legislative instrument
Plain English Summary
6/10 complexity
This instrument adds a defined set of cleft and craniofacial health services (Group C1) to be treated as both professional and medical services under the Health Insurance Act, fixes the Medicare item numbers and fees (Schedule 1), and lists the eligible patient conditions (Schedule 2). It limits which dental and medical specialists may claim the items and requires referrals for certain services. Medicare will pay the specified fees (with indexation from 1 July 2025) only when the provider and patient meet the rules.
This instrument, the Health Insurance (Section 3C General Medical Services - Cleft and Craniofacial Services) Determination 2024, operates by designating a set of dental, orthodontic, surgical and allied procedures as "relevant services" for the purposes of the Health Insurance Act 1973 and applying specified fees to those services. Mechanically, the core effect is established by section 6: a relevant service provided under the Determination is to be treated, for the relevant provisions, as if it were both a professional service and a medical service and as if there were an item in the general medical services table that specifies a fee for each State equal to the fee listed in Schedule 1 (s 6). In short, the Determination creates MBS‑style item entries for a discrete group of cleft and craniofacial services that previously were not expressed in the general medical services table in this form.
The instrument is made under subsection 3C(1) of the Health Insurance Act 1973 (s 3). It defines key provider categories and patient eligibility constraints (s 4 and Schedule 2), limits which items apply to which practitioners (s 7), imposes referral requirements for a subset of items (s 8), and prescribes an indexation step that takes effect on 1 July 2025 (s 9). Schedule 1 contains the item numbers, short descriptions and state‑indifferent fee amounts expressed in dollars. Schedule 2 contains a closed list of eligible cleft or craniofacial conditions for which the items may be claimed.
Procedurally the Determination does not itself create new clinical pathways; it overlays financial and administrative consequences on a defined set of services. Section 6 ties the Determination into the existing Health Insurance Act and National Health Act machinery by treating the specified services as if they were in the general medical services table, thereby bringing them under the "relevant provisions" that govern professional and medical services (s 4, definition of relevant provisions). Section 5 sets out the usual consequence of Schedules: any instrument specified in a Schedule is amended or repealed as set out in the Schedule, and Schedule items take effect according to their terms (s 5). In this instrument, Schedules 1 and 2 operate to set the list of covered services and the list of eligible patient conditions.
Current sections
Direct links to the current provisions in Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024.
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1
Name
1 Name
This instrument is the Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024.
3
Authority
3 Authority
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
4
Definitions
4 Definitions
(1) In this instrument:
Act means the Health Insurance Act 1973.
dental practitioner has the same meaning as subsection 3(1) of the Act.
eligible oral and maxillofacial surgeon means a dental practitioner who is recognised under the National Law in the speciality of oral and maxillofacial surgery.
eligible orthodontist means:
(a) a dental practitioner who is registered under National Law in the speciality of orthodontics; or
(b) a dental practitioner whose qualifications or experience were recognised by the Australian Society of Orthodontists, prior to 31 March 2013, as applicable to:
i. services mentioned in items 75002, 75005, 75007, 75012, 75015, and 75024 to 75051; or
ii. services mentioned in at least one of these items; or
(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.
Note: 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.
eligible paediatric dentist means a dental practitioner who is recognised under the National Law in the speciality of paediatric dentistry.
eligible prosthodontist means a dental practitioner who is recognised under the National Law in the speciality of prosthodontics.
medical practitioner has the same meaning as subsection 3(1) of the Act.
referring dentist means a dental practitioner who is recognised under the National Law in the dentists division of the dental profession.
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 table at Schedule 2.
Schedule means a Schedule to this instrument.
Note: 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:
general medical services table
item
National Law
professional service
(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.
5
Schedules
5 Schedules
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.
6
Relevant services
6 Relevant services
For 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:
(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 Schedule 1 in relation to the service.
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Limitation on services
7 Limitation on services
(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.
(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.
(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.
(4) Items 75002, 75005, 75007, 75618 and 75621 apply to a service provided by an eligible prosthodontist.
(5) Items 75002, 75005, 75007, 75024, 75027, 75600 and 75603 apply to a service provided by an eligible paediatric dentist.
(6) Items 75002, 75005, 75007, 75012, 75015, 75405, 75600, 75603, 75606, 75609, 75610, 75618 and 75621 apply to a service provided by:
(a) an eligible oral and maxillofacial surgeon; or
(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.
8
Requirement for referral by a referring dentist or medical practitioner
8 Requirement for referral by a referring dentist or medical practitioner
(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.
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Indexation
9 Indexation
(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:
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).
(2) The amounts covered by this subsection are the fee for each item in Schedule 1 of this Determination.
(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).
Schedule 1—Specified health services
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><thead><tr><td colspan="3" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Group C1</span><span style="font-size:10pt; font-weight:bold"></span><span style="font-size:10pt; font-weight:bold">—Cleft and Craniofacial Services</span></p></td></tr><tr><td style="width:9.1%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Item</span></p></td><td style="width:74.48%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Service</span></p></td><td style="width:16.42%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Fee ($)</span></p></td></tr></thead><tbody><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75002</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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)</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">94.10</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75005</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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)</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">47.35</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75007</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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:</span><span style="font-size:10pt"></span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:0pt; text-indent:0pt; font-size:10pt; display:inline-block"></span><span style="font-size:10pt"></span><span style="font-size:10pt">(a) </span><span style="font-size:10pt"></span><span style="font-size:10pt">item 75030, 75032, 75039, 75045 or 75051 apply; or</span><span style="font-size:10pt"></span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="font-size:10pt"></span><span style="font-size:10pt">(b) </span><span style="font-size:10pt"></span><span style="font-size:10pt">an item in Group T8 or Groups O3 to O9 apply; or</span><span style="font-size:10pt"></span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="font-size:10pt"></span><span style="font-size:10pt">(c) </span><span style="font-size:10pt"></span><span style="font-size:10pt">item 52321, 53212 or 75618 apply; or</span><span style="font-size:10pt"></span><span style="font-size:10pt"></span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="font-size:10pt"></span><span style="font-size:10pt">(d) </span><span style="font-size:10pt"></span><span style="font-size:10pt">any of items 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 apply;</span><span style="font-size:10pt"></span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">in a single treatment</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">83.85</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75009</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Orthodontic radiography—orthopantomography (panoramic radiography), including any consultation on the same occasion</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">75.05</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75010</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Orthodontic radiography – anteroposterior or lateral cephalometric radiography, with cephalometric tracings, and orthopantomography, including any consultation on the same occasion</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">151.80</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75011</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Orthodontic radiography – anteroposterior and lateral cephalometric radiography, with cephalometric tracings, and orthopantomography, including any consultation on the same occasion</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">197.90</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75012</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Orthodontic anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">118.95</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75015</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Radiography</span><span style="font-size:10pt"> </span><span style="font-size:10pt">anteroposterior and lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">163.50</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75023</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Intraoral radiography—single area, periapical or bitewing film</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">51.10</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75024</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Pre</span><span style="font-size:10pt">‑</span><span style="font-size:10pt">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</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">660.55</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75027</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Pre</span><span style="font-size:10pt">‑</span><span style="font-size:10pt">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</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">905.75</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75030</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Maxillary arch expansion (other than a service associated with a service to which item 75039, 75042, 75045 or</span><span style="font-size:10pt"> </span><span style="font-size:10pt">75048 applies), including supply of appliances and all adjustments of appliances, removal of appliances and retention</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">806.45</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75032</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">1815.80</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75034</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">672.80</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75039</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Permanent dentition treatment—single arch (mandibular or maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of</span><span style="font-size:10pt; font-style:italic"> </span><span style="font-size:10pt">appliances and aligners—initial 3</span><span style="font-size:10pt"> </span><span style="font-size:10pt">months of active treatment</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">611.20</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75042</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Permanent dentition treatment—single arch (mandibular or maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including</span><span style="font-size:10pt; font-style:italic"> </span><span style="font-size:10pt">supply of appliances and aligners—each subsequent 3</span><span style="font-size:10pt"> </span><span style="font-size:10pt">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</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">228.45</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75045</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Permanent dentition treatment—2 arch (mandibular and maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including</span><span style="font-size:10pt; font-style:italic"> </span><span style="font-size:10pt">supply of appliances or aligners—initial 3</span><span style="font-size:10pt"> </span><span style="font-size:10pt">months of active treatment</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">1,223.50</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75048</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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</span><span style="font-size:10pt"> </span><span style="font-size:10pt">months</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">313.75</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75049</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Retention, fixed or removable, single arch (mandibular or maxillary)—supply of retainer and supervision of retention</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">367.25</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75050</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Retention, fixed or removable, 2</span><span style="font-size:10pt">‑</span><span style="font-size:10pt">arch (mandibular and maxillary)—supply of retainers and supervision of retention</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">708.90</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75051</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">1,088.20</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75200</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Removal of tooth or tooth fragment (other than treatment to which item 75402 or 75405 applies)</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">60.45</span></p></td></tr><tr><td style="width:9.1%; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75203</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Removal of tooth or tooth fragment under general anaesthesia (H)</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">90.70</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75206</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Removal of each additional tooth or tooth fragment if provided in association with a service to which item</span><span style="font-size:10pt"> </span><span style="font-size:10pt">75200 or 75203 applies</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">30.10</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75400</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Surgical removal of erupted tooth</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">181.35</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75402</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableParagraph" style="margin-right:13.05pt; margin-left:1.3pt; line-height:104%; font-size:10pt"><span>Surgical removal of tooth, or tooth fragment requiring incision of soft tissue only</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">179.25</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75405</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Surgical removal of tooth, or tooth fragment requiring removal of bone, where the patient is referred by a referring dentist or medical practitioner</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">229.20</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75600</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Surgical exposure and packing of unerupted tooth</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">255.40</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75603</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Surgical exposure of unerupted tooth for the purpose of fitting a traction device or placement of a temporary anchorage device</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">300.25</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75606</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Surgical repositioning of unerupted tooth where the patient is referred by a referring dentist or medical practitioner</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">300.25</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75609</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Transplantation of tooth bud where the patient is referred by a referring dentist or medical practitioner</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">448.20</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><a id="CU_2017320"></a><span style="font-size:10pt">75610</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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)</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">380.00</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75618</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Fabrication and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">254.90</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75621</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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:</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:9.3pt; text-indent:0pt; font-size:10pt; display:inline-block"></span><span style="font-size:10pt">(a)</span><span style="width:6.25pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">any item in the following series applies:</span></p><p style="margin-left:43.4pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span style="width:26.86pt; text-indent:0pt; font-size:10pt; display:inline-block"></span><span style="font-size:10pt">(i)</span><span style="width:7.1pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">any of items 46150 to 46161 apply; or</span></p><p style="margin-left:43.4pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span style="width:19.08pt; text-indent:0pt; font-size:10pt; display:inline-block"></span><span style="font-size:10pt"></span><span style="font-size:10pt">(ii)</span><span style="width:7.1pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">any of items 52342 to 52375 apply; or</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:8.74pt; text-indent:0pt; font-size:10pt; display:inline-block"></span><span style="font-size:10pt">(b)</span><span style="width:6.25pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">item 52380 or 52382 applies;</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="font-size:10pt"></span><span style="font-size:10pt">(c)</span><span style="font-size:10pt"> </span><span style="font-size:10pt">item 75610 applies</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">254.90</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75800</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Attendance involving consultation, preventive treatment and prophylaxis, of not less than 30</span><span style="font-size:10pt"> </span><span style="font-size:10pt">minutes in duration</span><span style="font-size:10pt"> </span><span style="font-size:10pt">for each attendance to a maximum of 3</span><span style="font-size:10pt"> </span><span style="font-size:10pt">attendances in any 12</span><span style="font-size:10pt"> </span><span style="font-size:10pt">month period (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies)</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">90.70</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75802</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Fabrication and fitting of acrylic base partial denture, including retainers—1 to 4 teeth</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">463.20</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75815</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Fabrication and fitting of acrylic base partial denture, including retainers—5 to 9 teeth</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">683.45</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75818</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Fabrication and fitting of acrylic base partial denture or complete denture or overdenture, including retainers—10 to 12 teeth</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">806.45</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75820</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Fabrication and fitting of metal framework partial denture, including all components—1 to 4 teeth</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt; letter-spacing:-0.1pt">803.80</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75833</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Fabrication and fitting of metal framework partial denture including all components—5</span><span style="font-size:10pt"> </span><span style="font-size:10pt">to 9 teeth</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">1,164.95</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75836</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Fabrication and fitting of metal framework partial denture or complete denture or overdenture including all components—10</span><span style="font-size:10pt"> </span><span style="font-size:10pt">to 12 teeth</span><span style="font-size:10pt; text-decoration:line-through"></span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">1,333.05</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75842</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Adjustment of denture (other than a service associated with a service to which item 75802, 75815, 75818, 75820, 75833 or 75836 applies)</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">44.85</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75845</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Relining of denture by laboratory process and associated fitting</span><span style="font-size:10pt; text-decoration:line-through"></span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">224.15</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75848</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Remodelling and fitting of denture of more than 4</span><span style="font-size:10pt"> </span><span style="font-size:10pt">teeth</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">268.80</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75851</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Repair to metal framework of denture—1 or more points</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">134.45</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75854</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Addition of a tooth or teeth to a denture to replace extracted tooth or teeth, including taking of necessary impression</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">134.45</span></p></td></tr></tbody></table>
Schedule 2—Eligible cleft or craniofacial conditions
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
1 Name
1 Name
This instrument is the Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024.
3 Authority
3 Authority
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
4 Definitions
4 Definitions
(1) In this instrument:
Act means the Health Insurance Act 1973.
dental practitioner has the same meaning as subsection 3(1) of the Act.
eligible oral and maxillofacial surgeon means a dental practitioner who is recognised under the National Law in the speciality of oral and maxillofacial surgery.
eligible orthodontist means:
(a) a dental practitioner who is registered under National Law in the speciality of orthodontics; or
(b) a dental practitioner whose qualifications or experience were recognised by the Australian Society of Orthodontists, prior to 31 March 2013, as applicable to:
i. services mentioned in items 75002, 75005, 75007, 75012, 75015, and 75024 to 75051; or
ii. services mentioned in at least one of these items; or
(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.
Note: 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.
eligible paediatric dentist means a dental practitioner who is recognised under the National Law in the speciality of paediatric dentistry.
eligible prosthodontist means a dental practitioner who is recognised under the National Law in the speciality of prosthodontics.
medical practitioner has the same meaning as subsection 3(1) of the Act.
referring dentist means a dental practitioner who is recognised under the National Law in the dentists division of the dental profession.
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.
The Determination is therefore a financial and claims‑administration instrument rather than a clinical standard or licensing instrument. It prescribes who may claim which item numbers for which patients (s 7), and where referrals are required (s 8), and fixes the fees that will apply (Schedule 1, with indexation rules at s 9). The title and structure indicate the instrument’s purpose is to ensure that specified cleft and craniofacial services are recognised within the Health Insurance Act framework as professional and medical services with specified fees, but the instrument itself sets out only the legal mechanics for doing that (see s 6 and Schedule 1).
Main concepts
The Determination rests on a small number of structural concepts that determine entitlement, provider scope and payment quantum. These concepts are explicitly defined within the instrument and operate together to control access and payment.
Relevant service: Defined by reference to subsection 3C(8) of the Act, a "relevant service" for this Determination is any health service specified in the table at Schedule 2; section 6 then declares that a relevant service provided in accordance with the Determination is to be treated, for the relevant provisions, as if it were both a professional service and a medical service and as if an item in the general medical services table related to the service and specified the fee in Schedule 1 (s 6). The Determination therefore converts the Schedule 1 items into the functional equivalent of MBS items for the listed services.
Eligible providers: The instrument defines several provider classes by reference to the Health Insurance Act and the National Law. Definitions in s 4 include "dental practitioner" and "medical practitioner" as those terms are used in the Act, and creates specialty categories: eligible oral and maxillofacial surgeon, eligible orthodontist, eligible paediatric dentist and eligible prosthodontist. Those specialty categories require recognition under the National Law in the relevant specialty, except that the eligible orthodontist definition preserves certain historical recognitions for practitioners whose qualifications or registrations were recognised prior to specific cutoff dates (s 4(1), eligible orthodontist). These provider definitions are operationalised in section 7, which allocates item applicability by provider class.
Patient eligibility (eligible cleft or craniofacial condition): Section 7(1) restricts all items in Schedule 1 to services provided to patients with an eligible cleft or craniofacial condition as specified in Schedule 2. Schedule 2 is a closed list of conditions and syndromes (Table 9,Eligible cleft or craniofacial conditions). The Determination therefore imposes a diagnostic/condition gate: the fee and treatment items are claimable only where the patient has one of the listed conditions.
Item mapping and restrictions: Schedule 1 lists item numbers (for example 75002, 75005, 75007, etc.), textual service descriptions and fees. Section 7 subdivides which items apply to which provider types: for example, items 75009, 75010, 75011 and others apply to a "dental practitioner" (s 7(2)); various items are restricted to eligible orthodontists (s 7(3)), eligible prosthodontists (s 7(4)), eligible paediatric dentists (s 7(5)), and eligible oral and maxillofacial surgeons (s 7(6)). Cross‑item conditions appear in the item descriptions themselves (for example 75621 is available only in association with certain other items as set out in Schedule 1).
Referral requirement: Section 8 imposes an additional procedural constraint: a specified subset of items (including 75002, 75005, 75200, 75203, 75206, 75400, 75402, 75600, 75603, 75618 and 75621) apply to a service provided by an eligible oral and maxillofacial surgeon only if the patient has been referred by a referring dentist or medical practitioner (s 8(1)). This creates a referral gate for certain surgical items.
Indexation: Section 9 specifies an indexation event: at the start of 1 July 2025 each amount in Schedule 1 is multiplied by 1.024 and rounded to the nearest five cents (with rounding down if the amount is an exact multiple of 2.5 cents) (s 9(1)-(3)). The note points users to MBS Online for the indexed fees as at 2025.
Integration with existing law: The instrument explicitly imports meanings and operative regimes from the Health Insurance Act and the National Health Act and their regulations (s 4, definition of relevant provisions), and it states that expressions used have the same meanings as in the Act unless a contrary intention appears (s 4 Note). Thus the Determination functions as a targeted application of existing medical benefits law rather than an autonomous scheme.
In sum, the main concepts combine to create a set of MBS‑style fee items reserved to specified practitioner classes delivering treatment to patients who meet a closed diagnostic list, with referral requirements for certain surgical items and a scheduled indexation of fees.
Who it affects
The Determination’s effects are concentrated on three groups: (1) patients with the listed cleft or craniofacial conditions; (2) the specific classes of practitioners authorised to claim the items; and (3) the administrative/payer side that processes claims under the Health Insurance Act regime.
Patients: Only patients diagnosed with an eligible cleft or craniofacial condition in Schedule 2 may attract the items and fees in Schedule 1 (s 7(1) and Schedule 2). The list in Schedule 2 is detailed and condition‑specific: it includes oral and/or facial clefting (cleft lip, alveolus and/or palate and Tessier facial cleft), a lengthy list of congenital or hereditary craniofacial malformations and syndromes (for example, achondroplasia, Treacher Collins syndrome, Pierre Robin sequence, syndromic craniosynostoses such as Apert, Crouzon and Pfeiffer), hereditary conditions causing the absence of six or more permanent teeth, conditions where supernumerary teeth are a major feature (Cleidocranial dysplasia, Gardner’s syndrome), and developmental or hereditary enamel/dentine formation disorders (amelogenesis imperfecta, dentinogenesis imperfecta, regional odontodysplasia). Therefore the instrument is limited to a relatively circumscribed clinical population: patients outside that list are excluded from claiming these items (s 7(1)).
Practitioners and providers: The Determination allocates items to narrowly defined provider categories. Section 7 allocates particular items to:
dental practitioners (defined as in s 3(1) of the Act), for example items 75009-75011, 75200, 75203 etc. (s 7(2));
eligible orthodontists (as defined in s 4) for a specified set of items including 75002, 75005, 75007, 75012, 75015 and many others (s 7(3));
eligible prosthodontists for a narrower set of items (s 7(4));
eligible paediatric dentists for specific items (s 7(5)); and
eligible oral and maxillofacial surgeons and certain dental practitioners holding historical approvals for larger sets of items (s 7(6)).
The "eligible" specialty definitions require recognition under the National Law in the specified specialty, or capture transitional recognition arrangements for older practitioners in the case of orthodontists (s 4). A subset of items applicable to oral and maxillofacial surgeons is only claimable when the patient has been referred by a referring dentist or medical practitioner (s 8(1)), so referring practitioners are also implicated in the pathway to a claim.
Payer/administrative bodies: The Determination interfaces with the Health Insurance Act’s payment and claims systems by instructing that services are to be treated as if they were both professional and medical services and as if itemised in the general medical services table with the Schedule 1 fees (s 6). That means agencies or departments responsible for processing Medicare claims and benefits will be required to administer benefits in accordance with this Determination and the relevant provisions referenced in s 4 (which include applicable provisions of the Act and the National Health Act and their regulations). Section 9 also creates an administrative task: applying the specified indexation factor and rounding rules at the indexation time.
Ancillary affected actors: Private health insurers and hospital operators are not named in the Determination but will need to adapt their billing and invoicing practices where private billing interacts with these items. The instrument’s narrow eligibility and provider‑designation rules will also affect referral patterns and the triage decisions of referring dentists and medical practitioners, who must provide referrals when required for surgical items (s 8). Finally, professional registration bodies and employers of specialists must ensure practitioners have the necessary specialty recognition under the National Law to fall within the eligible categories defined in s 4.
Who pays and who decides: The Determination fixes the fee to be treated as the fee in the general medical services table (s 6). Whether or how a particular benefit is paid in a particular case will be governed by the Health Insurance Act and the "relevant provisions" that the Determination imports (s 4 definition). The practical result is that the Commonwealth’s health insurance regime will process and be exposed to claims for these Schedule 1 amounts subject to the Act’s rules and any applicable conditions.
Key duties and rights
The Determination imposes duties and creates contingent rights through three primary mechanisms: diagnostic limitation, provider qualification, and referral requirements. These operate alongside the existing duties and rights under the Health Insurance Act regime imported by the Determination.
Duty to restrict claims to eligible patients: All Schedule 1 items are available only for services provided to patients with an eligible cleft or craniofacial condition listed in Schedule 2; that is a duty on claimants and providers to ensure clinical eligibility (s 7(1)). Practically this requires documentation of the patient’s condition and the clinical basis for using the item, because entitlement under the Determination is conditioned on the diagnosis appearing in Schedule 2.
Duty to hold appropriate professional recognition: Several items are limited to practitioners with specified recognition under the National Law. For example, an "eligible oral and maxillofacial surgeon" must be a dental practitioner recognised under the National Law in that speciality (s 4). The eligible orthodontist and other eligible specialty definitions likewise require recognition under the National Law, with transitional recognition rules preserved for orthodontists with historic recognition (s 4). The duty is thus on practitioners and their employers to maintain appropriate registration and to ensure only properly recognised specialists claim the corresponding items (s 7(3)-(6)).
Referral duty for certain surgical items: Section 8(1) imposes a procedural duty that a set of items (including several surgical and procedure items) apply to an eligible oral and maxillofacial surgeon only if the patient has been referred by a "referring dentist or medical practitioner." The Determination requires the existence of a referral before those items can be claimed in respect of a service by an eligible oral and maxillofacial surgeon (s 8(1)). The duty rests on the referring practitioner to make a referral and on the surgeon to ensure the referral exists when claiming.
Right to treatment fees specified in Schedule 1 (conditional right): Where the conditions in s 6 and s 7 are satisfied,that is, the service is a relevant service, provided to a patient with an eligible condition, by an eligible provider and any referral condition is met,then the service is to be treated for the relevant provisions as if an item in the general medical services table specified the fee in Schedule 1 (s 6). This creates a conditional right for the provider or patient to have that fee recognised for purposes of benefit calculation under the relevant provisions of the Health Insurance Act and National Health Act (s 4, definition of relevant provisions).
Duty to observe cross‑item and associative conditions in Schedule 1: Several Schedule 1 items are expressly conditional on association with other items or on not being associated with certain items; for example item 75002 is an initial professional attendance "other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies" (Schedule 1), and item 75621 only applies "if provided in association with" certain item series (Schedule 1). These cross references impose duties on claimants to ensure correct claim construction and prevent double claiming or inappropriate aggregation.
Indexation duty: Section 9 imposes an indexation adjustment at a specified time (1 July 2025) that will alter the numeric fees set out in Schedule 1. The item amounts are to be multiplied by 1.024 and rounded to the nearest five cents; that is a rule the administrative system and claimants must respect (s 9(1)-(3)). The Determination does not itself change entitlement conditions but it changes the monetary quantum of the fees at the indexation time.
Documentary and administrative duties implied by the Act: The Determination imports the Health Insurance Act and National Health Act provisions as "relevant provisions" (s 4, definition). Those Acts include record‑keeping, honesty and fraud provisions and benefits recovery mechanisms. Although this Determination does not restate those provisions, it places the Schedule 1 items within that legal framework, so claimants and providers are governed by the Act’s duties when making claims for those items.
In summary, the Determination creates conditional entitlements to specified fees but predicates them on duties of clinical eligibility, appropriate registration recognition, referral (where required), correct claim construction and compliance with the existing Act‑level requirements imported as the "relevant provisions."
Penalties and enforcement
The Determination itself does not set out new penalty provisions; instead it imports the Health Insurance Act and the National Health Act legal architecture through its definition of "relevant provisions" and by treating services as if there were items in the general medical services table (s 6 and s 4, definition of relevant provisions). Enforcement and penalties therefore arise through the statutory machinery of those Acts rather than through novel sanctions in the Determination.
Enforcement framework by reference: Section 4 defines "relevant provisions" to mean "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." That means the Determination’s items are subject to the Act’s enforcement mechanisms that deal with improper claiming, benefit payback and criminal sanctions where applicable. The instrument places its items explicitly within that enforcement perimeter,so the usual Health Insurance Act mechanisms for benefit recovery, administrative sanctions, and criminal liability for fraudulent claims apply to claims made under these items.
Indirect enforcement via eligibility gates: The instrument’s eligibility and referral constraints (s 7 and s 8) create administrable checkpoints that can trigger audits and reviews. For example, claims for surgical items by an eligible oral and maxillofacial surgeon without a referral from a referring dentist or medical practitioner would fail the Determination’s precondition (s 8(1)), and would therefore be liable to administrative rejection or recovery action under the Act’s enforcement processes. Similarly, items claimed for patients not meeting Schedule 2’s diagnostic list would be vulnerable to review and clawback under the Act since the Determination makes the claim contingent on patient eligibility (s 7(1) and Schedule 2).
Administrative compliance and audit risk: Because the Determination imports the general medical services table style treatment (s 6), claims will enter the same processing pipelines used for MBS items. That typically triggers existing audit and compliance pathways under the Act (though the Determination does not itself list those pathways). Practitioners and providers must therefore expect the same administrative scrutiny that applies to other professional and medical service claims under the Health Insurance Act.
Indexation compliance: The indexation rule at s 9 will require administrative change in claims processing systems on 1 July 2025. Failure to apply the new indexed fee and rounding rules could result in incorrect payments and subsequent recovery action where overpayments occur; conversely underpayments could lead to disputes. The Determination includes a rounding rule that must be applied (s 9(3)), creating a precise compliance requirement.
No novel criminal penalties in the Determination: The text does not create fresh criminal offences or civil penalties beyond those embedded in the Health Insurance Act or National Health Act. Enforcement therefore follows existing statutory provisions. The Determination makes clear by reference that its items are to be handled under the "relevant provisions," which gives the Health Insurance Act the role of providing penalties and enforcement processes.
In short, enforcement and penalties applicable to claims under this Determination are those already established in the Health Insurance Act regime; the Determination attaches its items to that regime and thereby subjects claimants to the Act’s enforcement architecture (s 4; s 6).
How it interacts with other laws
The Determination is explicitly framed as an application of, and an addition to, the Health Insurance Act 1973 scheme and the National Health Act 1953 regime; it therefore interacts closely with those Acts and with the National Law provisions concerning health practitioner registration.
Primary statutory relationships: The instrument is made under subsection 3C(1) of the Health Insurance Act 1973 (s 3). Section 6 instructs that a relevant service provided in accordance with the Determination is to be treated, for the "relevant provisions," as if it were both a professional service and a medical service and as if there were an item in the general medical services table specifying the fee in Schedule 1. The "relevant provisions" are defined in s 4 to include all provisions relating to professional services or to medical services of the Health Insurance Act and regulations and the National Health Act and its regulations (s 4). Thus the Determination’s items are integrated into the Acts' benefit, claims, and enforcement systems.
Interaction with practitioner registration and the National Law: The Determination uses the National Law (the Health Practitioner Regulation National Law) as the basis for specialist recognition. Definitions such as "eligible oral and maxillofacial surgeon," "eligible orthodontist," "eligible paediatric dentist," and "eligible prosthodontist" require recognition under the National Law in the relevant specialty (s 4). That means a practitioner’s ability to lawfully render and claim a specified item under this Determination depends on their registration status under the National Law. The instrument thereby links MBS‑style payment entitlements to registration categories administered by state and territory registration boards operating under the National Law framework.
Cross‑references and item interdependencies with other MBS or dental items: Several Schedule 1 descriptions cross‑reference other item numbers and item series (for example, item 75007's production of dental study models refers to items 75030, 75032, 75039, etc., and item 75621 lists multiple item series to which it must be associated). The Determination thereby creates interaction points with other items that may already exist in the general medical services table or in other schedules. Where those other items are themselves governed by provisions in the Health Insurance Act or National Health Act, the interplay will be governed by the Acts’ rules on item relationships and claim construction.
Interaction with state and territory law: Section 6 requires that Schedule 1 specify for each service a fee in relation to each State (s 6(b)(ii)), but the Schedule lists single fee amounts without separately itemised State columns. The instrument notes that expressions used have the same meanings as in the Act and refers to the Legislation Act 2003 for expressions that carry through from the Act (s 4 Note). While the Determination does not explicitly alter state health law, by embedding fees and item recognition into the national Health Insurance Act regime it affects billing flows that intersect with state‑funded public hospitals, private hospital billing, and the practice of specialists who may work across public and private settings. Claimants will need to reconcile this Determination with any state or territory obligations relating to practice privileges, delegated services and facility billing.
Administrative interplay with MBS Online and departmental processes: Section 9’s note directs readers to the Department of Health and Aged Care’s MBS Online website for indexed fees in 2025. This demonstrates an operational interaction: the Determination sets legal entitlements while administrative presentation and updated numeric fees are handled through departmental publication and claims systems.
No change to other Acts’ substantive clinical regulation: The Determination does not purport to change the regulatory rules in the National Law governing professional conduct, nor does it modify licensing under state hospital law. It creates a pattern of entitlements under the Health Insurance Act regime and relies on the National Law and the Health Insurance Act to supply the regulatory overlay.
In summary, the Determination functions as a targeted payment‑rules instrument that binds Schedule 1 items into the Health Insurance Act and National Health Act frameworks and ties practitioner entitlement to registration under the National Law. That integration determines both who may claim and which statutory enforcement, registration and administrative regimes will apply.
Amendment history
The text of the Determination as provided does not include a narrative history of prior instruments or modifications. The instrument’s own clause 5 states the ordinary rule for Schedules: each instrument specified in a Schedule is amended or repealed as set out in the applicable items in that Schedule, and any other item in a Schedule has effect according to its terms (s 5). In this Determination, Schedules 1 and 2 operate as the operative lists of service items and eligible conditions. There are no express amendment entries in the Schedules as printed that indicate this Determination is amending or repealing existing legislative instruments; instead Schedules 1 and 2 present new lists to which the Determination gives effect.
The Determination is made under s 3C(1) of the Health Insurance Act 1973 (s 3). That subsection is the statutory head of power used by the Minister to specify services to be treated as medical and professional services under the general medical services table. The instrument therefore sits in the routine architecture of determinations made under s 3C(1). The Determination itself contains transitional‑style vesting or preservation features within its definitions,most notably the eligible orthodontist definition preserves recognitions for practitioners whose qualifications or experience were recognised by the Australian Society of Orthodontists prior to 31 March 2013, and for those who were registered orthodontists immediately prior to 1 November 2012 under rule 2.59.2(3)(b) of the general medical services table or equivalent historical provisions (s 4, eligible orthodontist). Those clauses function as embedded transitional provisions rather than as amendment history.
Because the instrument is self‑contained and does not list prior versions or amendment dates, any formal amendment history,such as revocations, replacements or earlier determinations implementing similar items,must be traced through the administrative records and the consolidated instruments database held by the responsible Department or by the Federal Register of Legislation. The Determination itself provides no chronology beyond its own operative provisions.
Practitioners and administrators should note that s 5 contemplates that Schedules may amend or repeal other instruments if those instruments are specified, and therefore future or prior versions of this Determination might contain amendment items; however, in the present text the Schedules function simply to set out the items and eligible conditions for this Determination. Any change to Schedule 1 fees or Schedule 2 conditions in future will be effected by amending instruments made under the same statutory head of power and published as such; those amendments will then create the visible amendment history that is absent from the current instrument.
Finally, section 9 provides for indexation that will change the numeric fees at a future time (1 July 2025) using a formula (multiply by 1.024 and round to the nearest five cents). That indexation mechanism constitutes a built‑in modification schedule for the numerical fees, and must be treated as the Determination’s own prospective amendment to the Schedule 1 fee amounts at the specified indexation time (s 9(1)-(3)).
Litigation history
The instrument text does not cite or summarise any litigation. It contains no references to cases, judicial decisions, or existing litigation involving these items. The Determination operates as a statutory administrative instrument under the Health Insurance Act (s 3), and any disputes about its application or a particular claim would be governed by the administrative and judicial review pathways available under the Act and general administrative law, not by this Determination’s text itself.
Because the Determination assimilates Schedule 1 items into the general medical services table for the purposes of the "relevant provisions" (s 6), disputes about benefits, eligibility, claim rejection, recovery of overpayments or allegations of inappropriate claiming would proceed under the enforcement and review mechanisms embedded in the Health Insurance Act and the National Health Act, including any internal departmental review and merits review pathways, and judicial review to the extent permitted by general administrative law. The Determination does not contain or identify any precedent or litigation outcomes related to its provisions.
Absent further materials appended to the Determination, there is no litigation history accessible within this instrument. Practitioners seeking case law concerning the application of items similar to those in Schedule 1 will need to search external sources: the Determination itself provides no case citations nor a litigation record.
Gotchas
The Determination contains several practical traps and detail points that practitioners, billing officers and administrators must watch closely. These are operational rather than conceptual; failure to observe them can lead to incorrect claims or adverse administrative outcomes.
Strict diagnostic gate: Every Schedule 1 item "only applies to a service provided to a patient with an eligible cleft or craniofacial condition, as specified in the table at Schedule 2" (s 7(1)). The list in Schedule 2 is specific and excludes many broader facial or dental pathologies. A clinician who claims these items for a patient whose condition is not listed in Schedule 2 risks an administratively invalid claim. The Determination does not provide a residual category; absence from Schedule 2 equals ineligibility under the Determination.
Provider specialty recognition nuance: The "eligible orthodontist" definition preserves multiple historical recognition paths: registration under the National Law in orthodontics, recognition by the Australian Society of Orthodontists prior to 31 March 2013 for certain items, or registration as a registered orthodontist immediately prior to 1 November 2012 under a specified rule (s 4). These transitional recognition clauses can catch billing administrators unaware, particularly in practices with long‑standing specialists whose status derives from historical approvals. Documentation proving the applicable historical recognition may be required.
Item eligibility by practitioner class: Section 7 divides items across practitioner types. For example, items 75002, 75005 and 75007 are allocated to multiple specialties (orthodontists, prosthodontists and paediatric dentists in varying permutations), but other items are strictly allocated to dental practitioners or to eligible oral and maxillofacial surgeons (s 7(2)-(6)). Misallocating an item to a non‑authorised practitioner will create an invalid claim.
Referral requirement scope: Section 8(1) restricts a set of items applicable to an eligible oral and maxillofacial surgeon unless the patient is referred by a "referring dentist or medical practitioner." The Determination does not define the content of the referral beyond that referral source requirement; hence the existence, date, and naming of a referring clinician will be material in any audit. Billing staff should ensure referrals are retained and match claim dates and item numbers.
Complex cross‑item associations inside Schedule 1: Several items are only claimable in association with other series or are expressly excluded from association with certain items. Example: item 75002 excludes services associated with items 75009, 75012, 75015 or 75023 (Schedule 1). Item 75621 applies only where associated with specified item series or item 75610 (Schedule 1). These cross‑references require careful claim assembly so that the same clinical encounter is not incorrectly split or double‑claimed.
Indexation timing and rounding: Section 9 sets a specific indexation event at the start of 1 July 2025, with multiplication by 1.024 and rounding to the nearest five cents (round down if exactly 2.5 cents). Billing systems must implement this change on that date. Failure to apply the new amounts or rounding rule will lead to mismatch between system payments and the statutory rate (s 9(1)-(3)).
Ambiguity about state fees: Section 6(b)(ii) requires that the item specify a fee in relation to each State, but Schedule 1 presents single dollar amounts without separate State columns. It appears the fee is intended to be uniform by State as listed. Nonetheless, practitioners should check departmental publication (MBS Online) for any state‑specific entries or clarifications (s 9 Note).
H and other item qualifiers: Some Schedule 1 items include "H" or other qualifiers (for example 75203 is labelled “under general anaesthesia (H)”), which may invoke hospital or admission‑related rules in the Health Insurance Act or National Health Act regimes. Practitioners must check the broader Act provisions that apply to H items, for eligibility, facility requirements and billing treatment.
No explicit administrative guidance attached: The Determination sets legal entitlements but contains no clinical guidance or procedural templates (for referrals, for example). Practices will need to develop internal processes to demonstrate compliance with the Determination’s conditions.
In summary, pay attention to: (1) the closed list of eligible conditions in Schedule 2; (2) practitioner specialty recognition and transitional provisions; (3) item allocation by practitioner class; (4) referral requirements for surgical items; (5) cross‑item associations and exclusions inside Schedule 1; and (6) the indexation event and rounding rules in s 9. Each of these is a concrete compliance pivot grounded in the Determination’s text.
How to comply
For practitioners, clinic managers and billing officers, compliance requires a small but precise checklist that maps the Determination’s conditions to administrative practice. The following steps are grounded in the instrument’s provisions.
Confirm patient eligibility against Schedule 2 (s 7(1) and Schedule 2)
Before claiming any Schedule 1 item, obtain and keep clinical documentation demonstrating the patient’s diagnosis matches one of the eligible cleft or craniofacial conditions in Schedule 2. The Determination conditions payment on that diagnosis. Examples in Schedule 2 include cleft lip/palate, Tessier facial cleft, syndromic craniosynostoses (Apert, Crouzon) and specified hereditary enamel/dentine disorders.
Verify practitioner registration and "eligible" status (s 4; s 7)
Ensure the practitioner claiming the item meets the definition of the appropriate "eligible" category. For example, an "eligible orthodontist" must be registered under the National Law in orthodontics or satisfy the transitional recognition paths noted in s 4. Retain proof of specialty recognition under the National Law or evidence of the historical recognition where applicable. If the item is allocated to an eligible prosthodontist or paediatric dentist (s 7(4)-(5)), confirm that National Law recognition exists.
Observe item allocation by practitioner class (s 7)
Match the clinical service to the specific item number and ensure that that item is allocated to the practitioner’s class per s 7. For example, items 75009-75011 apply to a dental practitioner (s 7(2)), while a number of orthodontic treatment items (75030, 75032, 75039, 75045, etc.) are allocated to eligible orthodontists (s 7(3)). Using the wrong item for a provider class will render the claim out of scope.
Obtain and retain referrals where required (s 8)
For items listed in s 8(1) that apply to an eligible oral and maxillofacial surgeon, secure a referral from a referring dentist or medical practitioner before providing the service. Document the referral (date, identity of referrer, reason) and retain it in records to support any audit or claim review. Where a claim depends on referral, the absence of a referral is a determinative compliance failure under this Determination.
Respect cross‑item dependencies and exclusions (Schedule 1)
Read the text of each Schedule 1 item carefully to confirm whether the item may or may not be claimed in association with others. For instance, item 75002 excludes services associated with certain radiography items (75009, 75012, 75015, 75023), and item 75621 is conditional on association with specific item series. Construct claims to reflect these dependencies and avoid double counting or conflicting item combinations.
Prepare for indexation at 1 July 2025 (s 9)
Update billing systems to apply the indexation formula set out in s 9(1) at the start of 1 July 2025: multiply each Schedule 1 amount by 1.024 and round to the nearest five cents according to s 9(3). Where your billing software is maintained by a third party, confirm their rollout schedule and test claims to ensure the correct post‑indexation amounts are used. Refer to MBS Online for the indexed listing as anticipated in s 9 Note.
Maintain records consistent with the Health Insurance Act requirements (s 4)
Because the Determination places these items within the Health Insurance Act and the National Health Act frameworks (s 4; s 6), providers must maintain the records and documentation required under those Acts, including clinical notes, referral documents, registration evidence and billing records. Adopt a consistent retention policy to enable responses to audits.
Coordinate with administrative and hospital billing where H items appear (Schedule 1)
Some items are noted as involving general anaesthesia or hospital contexts (for example 75203 and 75610 are labelled "(H)" in Schedule 1). Where an item raises hospital admission or facility interactions, coordinate billing between practitioner and facility to ensure correct assignment of items, and ensure the facility requirements in the Health Insurance Act or National Health Act are satisfied.
Implement internal checks and staff training
Train clinical and billing staff on the Determination’s eligibility, provider and referral requirements. Implement a pre‑claim checklist that verifies: (a) the patient’s condition is on Schedule 2; (b) the practitioner holds the necessary specialty recognition; (c) any required referral is on file; and (d) cross‑item exclusions/associations are respected.
Monitor for departmental updates and future amendments
The Determination’s s 5 architecture allows future Schedules to amend or repeal specified instruments; monitor departmental publications and MBS Online for any changes to Schedule 1 or Schedule 2. Administrative fee displays on MBS Online should be checked, particularly after the indexation date in s 9.
Following these steps will align operational practice with the statutory preconditions set out in this Determination. The core compliance principle is simple: do not claim Schedule 1 items unless the statutory preconditions in s 6, s 7 and, where applicable, s 8 are met and documented.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the table at Schedule 2.
Schedule means a Schedule to this instrument.
Note: 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:
general medical services table
item
National Law
professional service
(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.
5 Schedules
5 Schedules
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.
6 Relevant services
6 Relevant services
For 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:
(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 Schedule 1 in relation to the service.
7 Limitation on services
7 Limitation on services
(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.
(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.
(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.
(4) Items 75002, 75005, 75007, 75618 and 75621 apply to a service provided by an eligible prosthodontist.
(5) Items 75002, 75005, 75007, 75024, 75027, 75600 and 75603 apply to a service provided by an eligible paediatric dentist.
(6) Items 75002, 75005, 75007, 75012, 75015, 75405, 75600, 75603, 75606, 75609, 75610, 75618 and 75621 apply to a service provided by:
(a) an eligible oral and maxillofacial surgeon; or
(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.
8 Requirement for referral by a referring dentist or medical practitioner
8 Requirement for referral by a referring dentist or medical practitioner
(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.
9 Indexation
9 Indexation
(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:
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).
(2) The amounts covered by this subsection are the fee for each item in Schedule 1 of this Determination.
(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).
Schedule 1—Specified health services
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><thead><tr><td colspan="3" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Group C1</span><span style="font-size:10pt; font-weight:bold"></span><span style="font-size:10pt; font-weight:bold">—Cleft and Craniofacial Services</span></p></td></tr><tr><td style="width:9.1%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Item</span></p></td><td style="width:74.48%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Service</span></p></td><td style="width:16.42%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Fee ($)</span></p></td></tr></thead><tbody><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75002</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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)</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">94.10</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75005</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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)</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">47.35</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75007</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">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:</span><span style="font-size:10pt"></span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:0pt; text-indent:0pt; font-size:10pt; display:inline-block"></span><span style="font-size:10pt"></span><span style="font-size:10pt">(a) </span><span style="font-size:10pt"></span><span style="font-size:10pt">item 75030, 75032, 75039, 75045 or 75051 apply; or</span><span style="font-size:10pt"></span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="font-size:10pt"></span><span style="font-size:10pt">(b) </span><span style="font-size:10pt"></span><span style="font-size:10pt">an item in Group T8 or Groups O3 to O9 apply; or</span><span style="font-size:10pt"></span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="font-size:10pt"></span><span style="font-size:10pt">(c) </span><span style="font-size:10pt"></span><span style="font-size:10pt">item 52321, 53212 or 75618 apply; or</span><span style="font-size:10pt"></span><span style="font-size:10pt"></span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="font-size:10pt"></span><span style="font-size:10pt">(d) </span><span style="font-size:10pt"></span><span style="font-size:10pt">any of items 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 apply;</span><span style="font-size:10pt"></span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">in a single treatment</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">83.85</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75009</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Orthodontic radiography—orthopantomography (panoramic radiography), including any consultation on the same occasion</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">75.05</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75010</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Orthodontic radiography – anteroposterior or lateral cephalometric radiography, with cephalometric tracings, and orthopantomography, including any consultation on the same occasion</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt">151.80</span></p></td></tr><tr><td style="width:9.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">75011</span></p></td><td style="width:74.48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span style="font-size:10pt">Orthodontic radiography – anteroposterior and lateral cephalometric radiography, with cephalometric tracings, and orthopantomography, including any consultation on the same occasion</span></p></td><td style="width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt;
This is an opening excerpt, not the complete document.