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Determinations/Health as amended, taking into account amendments up to Health Insurance (Section 3C General Medical Services – Cleft Lip and Cleft Palate Services) Amendment Determination 2019
Administered by: Health
Registered 25 Jul 2019
Start Date 01 Jul 2019

Commonwealth Coat of Arms

Health Insurance (Cleft Lip and Cleft Palate Services) Determination 2012

made under subsection 3C(1) of the

Health Insurance Act 1973

Compilation No. 2

Compilation date:                              1 July 2019

Includes amendments up to:            F2019L00602

Registered:                                         25 July 2019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prepared by the Office of Parliamentary Counsel, Canberra


About this compilation

This compilation

This is a compilation of the Health Insurance (Cleft Lip and Cleft Palate Services) Determination 2012 that shows the text of the law as amended and in force on 1 July 2019 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

.


Contents

Name of Determination                                                                                              4

4  Definitions                                                                                                                  4

5   Treatment of relevant services                                                                                    5

6   Limitation on services                                                                                                 5

Schedule                                                                                                                         7

Part 1                     Group C1 Orthodontic services and fees                                         7

Part 2                     Group C2 Oral and maxillofacial services and fees                         9

Part 3                     Group C3 General and prosthodontic services and fees                11

Endnotes                                                                                                                       12

 


1            Name of Determination

              This Determination is the Health Insurance (Cleft Lip and Cleft Palate services) Determination 2012

4              Definitions

(1)   In this Determination:

Act means the Health Insurance Act 1973.

dental practitioner means a practitioner registered under a law of a State or Territory in the division of dentist.

eligible oral and maxillofacial surgeon means a practitioner described in subsection 6(6) of this Determination.

eligible orthodontist means a dental practitioner described in subsection 6(2) of this Determination.

GMST Regulations 2011 means the Health Insurance (General Medical Services Table) Regulations 2011.

Note          The Health Insurance (General Medical Services Table) Regulations 2011 commenced on 1 November 2011.

medical practitioner means a practitioner registered under a law of a State or Territory as a medical practitioner.

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 Schedule.

Schedule means the Schedule to this Determination.

Note          Unless the contrary intention appears, expressions used in this Determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.  Terms defined in the Act include:

·         general medical services table

·         item

·         professional service

(2)    Unless the contrary intention appears, a reference in this Determination 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              Treatment of relevant services

                For subsection 3C (1) of the Act, a relevant service provided in accordance with this Determination 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 the Schedule in relation to the service.

 

Note       For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.

 

6              Limitation on services

(1)    Items 75001 to 75854 apply only to a service provided to a prescribed dental patient.

Note     For the meaning of a prescribed dental patient, see section 3BA of the Act

(2)     Subject to subsection (5), items 75001 to 75006 or 75024 to 75051 that include the symbol (AO) apply only to a service provided:

(a) by a dental practitioner who is registered under a law of a State or Territory in the specialty of orthodontics; or

(b) by a dental practitioner:

                          (i)    who is not registered under a law of a State or Territory in the specialty of orthodontics; and

                         (ii)    whose qualifications or experience demonstrate to the Australian Society of Orthodontists, prior to 31 March 2013, his or her competence in the field of orthodontics that is applicable to the giving of:

                                   (A)     services mentioned in items 75001 to 75006 or 75024 to 75051; or

                                   (B)     services mentioned in at least 1 of these items; or

(c) a dental practitioner who, immediately prior to this determination commencing, was an accredited orthodontist as defined in rule 2.59.2(3)(b) of the GMST Regulations 2011 or any equivalent provision of preceding regulations.

(3)     Subject to subsection (5), items 75009 to 75023 that include the symbol (AO) and the symbol (AOS) apply only to a service provided by:

(a) a dental practitioner who is registered under a law of a State or Territory in the specialty of orthodontics; or

(b) a dental practitioner:

                          (i)    who is not registered under a law of a State or Territory in the specialty of orthodontics; and



                         (ii)    whose qualifications or experience demonstrate to the Australian Society of Orthodontists, prior to 31 March 2013, his or her competence in the field of orthodontics that is applicable to the giving of:

                                   (A)     services mentioned in items 75009 to 75023; or

                                   (B)     services mentioned in at least 1 of these items;

(c) a medical practitioner who is a specialist in the practice of his or her specialty of oral and maxillofacial surgery; or

(d) a dental practitioner who, immediately prior to this determination commencing, was an accredited orthodontist as defined in rule 2.59.2(3)(b) of the GMST Regulations 2011 or any equivalent provision of preceding regulations; or

 (e) a dental practitioner who, immediately prior to this determination commencing, held an approval granted by the Minister for the purposes of the definition of professional service in subsection 3(1) of the Act.

(4)     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 GMST Regulations 2011, 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.

(5)     If a service described in an item mentioned in subsection (2) or (3) is performed by a dental practitioner described in paragraph (2)(b), (2)(c), (3)(b) or (3)(d), the item for the service applies only if the dental practitioner’s experience or qualifications demonstrated his or her competence in the field of orthodontics applicable to the giving of the service mentioned in that item.

(6)     Items 75150 to 75156 or 75400 to 75621 that include the symbol (AOS) apply only to a service provided by:

(a) a medical practitioner who is a specialist in the practice of his or her specialty of oral and maxillofacial surgery; or

(b) a dental practitioner who, immediately prior to this determination commencing, held an approval granted by the Minister for the purposes of the definition of professional service in subsection 3(1) of the Act.

(7)     Items 75200 to 75206 or 75800 to 75854 that include the symbol (AD) apply only to a service provided by a dental practitioner


Schedule                Specified health services

Part 1          Group C1 Orthodontic services and fees

Category 7 – Cleft Lip and Cleft Palate Services

Group C1 – Orthodontic Services

Item

Service

Fee ($)

75001

Initial professional attendance in a single course of treatment by an eligible orthodontist (AO)

86.90

75004

Professional attendance by an eligible orthodontist after the first professional attendance by the orthodontist in a single course of treatment (AO)

43.70

75006

Production of dental study models (other than a service associated with a service to which item 75004 applies) before provision of a service to which:

    (a)   item 75030, 75033, 75034, 75036, 75037, 75039, 75045 or 75051 applies; or

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

in a single course of treatment (AO)

77.45

75009

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

69.25

75012

Orthodontic radiography — anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings including any consultation on the same occasion (AOS) (AO)

109.80

75015

Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings including any consultation on the same occasion (AOS) (AO)

150.95

75018

Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography including any consultation on the same occasion (AOS) (AO)

192.30

75021

Orthodontic radiography — hand‑wrist studies (including growth prediction) including any consultation on the same occasion (AOS) (AO)

235.75

75023

Intraoral radiography — single area, periapical or bitewing film (AOS) (AO)

47.20

75024

Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 1 appliance is used (AO)

609.70

75027

Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 2 appliances are used (AO)

836.05

75030

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

744.40

75033

Mixed dentition treatment — incisor alignment using fixed appliances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of the appliances and retention (AO)

1,220.15

75034

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

621.05

75036

Mixed dentition treatment — lateral arch expansion and incisor alignment using fixed appliances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of appliances and retention (AO)

1,685.30

75037

Mixed dentition treatment — lateral arch expansion and incisor correction — 2 arch (maxillary and mandibular) using fixed appliances in both maxillary and mandibular arches, including supply of appliances, all adjustments of appliances, removal of appliances and retention (AO)

2,122.60

75039

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

564.15

75042

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

210.85

75045

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

1,129.35

75048

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

289.60

75049

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

338.95

75050

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

654.35

75051

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

1,004.45


Part 2         Group C2 Oral and maxillofacial services and fees

Category 7 – Cleft Lip and Cleft Palate Services

Group C2 – Oral and Maxillofacial Services

Item

Service

Fee ($)

75150

Initial professional attendance in a single course of treatment by an eligible oral and maxillofacial surgeon if the patient is referred to the surgeon by an eligible orthodontist (AOS)

86.90

75153

Professional attendance by an eligible oral and maxillofacial surgeon after the first professional attendance by the surgeon in a single course of treatment if the patient is referred to the surgeon by an eligible orthodontist (AOS)

43.70

75156

Production of dental study models (other than a service associated with a service to which item 75153 applies) before provision of a service:

    (a)   to which item 52321, 53212 or 75618 applies; or

    (b)   to which an item in the series 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 applies;

in a single course of treatment, if the patient is referred by an eligible orthodontist (AOS)

77.45

75200

Removal of tooth or tooth fragment (other than treatment to which item 75400, 75403, 75406, 75409, 75412 or 75415 applies), if the patient is referred by an eligible orthodontist (AD)

55.80

75203

Removal of tooth or tooth fragment under general anaesthesia, if the patient is referred by an eligible orthodontist (AD)

83.75

75206

Removal of each additional tooth or tooth fragment at the same attendance at which a service to which item 75200 or 75203 applies is rendered, if the patient is referred by an eligible orthodontist (AD)

27.80

75400

Surgical removal of erupted tooth, if the patient is referred by an eligible orthodontist (AOS)

167.40

75403

Surgical removal of tooth with soft tissue impaction, if the patient is referred by an eligible orthodontist (AOS)

192.30

75406

Surgical removal of tooth with partial bone impaction, if the patient is referred by an eligible orthodontist (AOS)

219.10

75409

Surgical removal of tooth with complete bone impaction, if the patient is referred by an eligible orthodontist (AOS)

248.15

75412

Surgical removal of tooth fragment requiring incision of soft tissue only, if the patient is referred by an eligible orthodontist (AOS)

138.60

75415

Surgical removal of tooth fragment requiring removal of bone, if the patient is referred by an eligible orthodontist (AOS)

167.40

75600

Surgical exposure, stimulation and packing of unerupted tooth, if the patient is referred by an eligible orthodontist (AOS)

235.75

75603

Surgical exposure of unerupted tooth for the purpose of fitting a traction device, if the patient is referred by an eligible orthodontist (AOS)

277.10

75606

Surgical repositioning of unerupted tooth, if the patient is referred by an eligible orthodontist (AOS)

277.10

75609

Transplantation of tooth bud, if the patient is referred by an eligible orthodontist (AOS)

413.65

75612

Surgical procedure for intra oral implantation of osseointegrated fixture (first stage), if the patient is referred by an eligible orthodontist (AOS)

511.90

75615

Surgical procedure for fixation of trans‑mucosal abutment (second stage of osseointegrated implant), if the patient is referred by an eligible orthodontist (AOS)

189.50

75618

Provision and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome, if the patient is referred by an eligible orthodontist (AOS)

235.30

75621

The provision and fitting of surgical template in conjunction with orthognathic surgical procedures in association with:

    (a)   an item in the series:

            (i)   45720 to 45754; or

           (ii)   52342 to 52375; or

    (b)   item 52380 or 52382;

if the patient is referred by an eligible orthodontist (AOS)

235.30


Part 3          Group C3 General and prosthodontic services and fees

Category 7 – Cleft Lip and Cleft Palate Services

Group C3 – General and Prosthodontic Services

Item

Service

Fee ($)

75800

Attendance comprising consultation, preventive treatment and prophylaxis, of not less than 30 minutes in duration — each attendance to a maximum of 3 attendances in any period of 12 months (AD)

83.75

75803

Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD)

335.05

75806

Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD)

392.95

75809

Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD)

465.30

75812

Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD)

517.00

75815

Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD)

630.85

75818

Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD)

744.40

75821

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD)

599.60

75824

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD)

692.70

75827

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD)

796.30

75830

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD)

878.95

75833

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD)

1,075.30

75836

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD)

1,230.45

75839

Provision and fitting of retainers (other than treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) — each retainer (AD)

27.80

75842

Adjustment of partial denture (other than treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) (AD)

41.40

75845

Relining of partial denture by laboratory process and associated fitting (AD)

206.90

75848

Remodelling and fitting of partial denture of more than 4 teeth (AD)

248.15

75851

Repair to cast metal base of partial denture — 1 or more points (AD)

124.10

75854

Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD)

124.10

 


Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

 

Endnote 2—Abbreviation key

ad = added or inserted

pres = present

am = amended

prev = previous

c = clause(s)

(prev) = previously

Ch = Chapter(s)

Pt = Part(s)

def = definition(s)

r = regulation(s)/rule(s)

Dict = Dictionary

Reg = Regulation/Regulations

disallowed = disallowed by Parliament

reloc = relocated

Div = Division(s)

renum = renumbered

exp = expired or ceased to have effect

rep = repealed

hdg = heading(s)

rs = repealed and substituted

LI = Legislative Instrument

s = section(s)

LIA = Legislative Instruments Act 2003

Sch = Schedule(s)

mod = modified/modification

Sdiv = Subdivision(s)

No = Number(s)

SLI = Select Legislative Instrument

o = order(s)

SR = Statutory Rules

Ord = Ordinance

Sub‑Ch = Sub‑Chapter(s)

orig = original

SubPt = Subpart(s)

par = paragraph(s)/subparagraph(s)

 

/sub‑subparagraph(s)

 

Endnote 3—Legislation history

 

Title

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Cleft Lip and Cleft Palate Services) Determination 2012

31 Oct 2013 (F2012L02113)

1 Nov 2012

 

Health Insurance (Cleft Lip and Cleft Palate Services) Amendment  Determination 2013

23 Oct 2013 (F2013L01825)

1 Nov 2013

Health Insurance (Section 3C General Medical Services – Cleft Lip and Cleft Palate Services) Amendment Determination 2019

10 Apr 2019 (F2019L00602)

1 July 2019

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2...........................................

rep LA 48D

s 3...........................................

rep F2013L01825

Schedule

 

Part 1

 

Part 1.......................................

am F2019L00602

Part 2

 

Part 2.......................................

am F2019L00602

Part 3

 

Part 3.......................................

am F2019L00602