Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024
made under subsection 3C(1) of the
Health Insurance Act 1973
Compilation No. 2
Compilation date: 1 March 2025
Includes amendments: F2025L00074
About this compilation
This compilation
This is a compilation of the Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024 that shows the text of the law as amended and in force on 1 March 2025 (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 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 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.
Editorial changes
For more information about any editorial changes made in this compilation, see 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 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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
1 Name
This instrument is the Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024.
3 Authority
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
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
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
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
(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, 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
(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
(1) At the start of 1 July 2024 (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 2024 be viewed on the Department of Health and Aged Care’s MBS Online website (http://www.health.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
Group C1—Cleft and Craniofacial Services |
Item | Service | Fee ($) |
75002 | Initial professional attendance, in a single course of treatment (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies) | 94.10 |
75005 | Subsequent professional attendance in a single course of treatment (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies) | 47.35 |
75007 | Production of dental study models (other than a service associated with a service to which item 75002 or 75005 applies) prior to provision of a service to which: (a) item 75030, 75032, 75039, 75045 or 75051 apply; or (b) an item in Group T8 or Groups O3 to O9 apply; or (c) item 52321, 53212 or 75618 apply; or (d) any of items 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 apply; in a single treatment | 83.85 |
75009 | Orthodontic radiography—orthopantomography (panoramic radiography), including any consultation on the same occasion | 75.05 |
75012 | Orthodontic anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion | 118.95 |
75015 | Radiography anteroposterior and lateral cephalometric radiography with cephalometric tracings, including any consultation on the same occasion | 163.50 |
75023 | Intraoral radiography—single area, periapical or bitewing film | 51.10 |
75024 | Pre‑surgical infant maxillary arch repositioning including nasoalveolar moulding, supply of appliances and all adjustments of appliances, and supervision of all components of the service—if 1 appliance is used | 660.55 |
75027 | Pre‑surgical infant maxillary arch repositioning including nasoalveolar moulding, supply of appliances and all adjustments of appliances, and supervision of all components of the service—if 2 appliances are used | 905.75 |
75030 | Maxillary arch expansion (other than a service associated with a service to which item 75039, 75042, 75045 or 75048 applies), including supply of appliances and all adjustments of appliances, removal of appliances and retention | 806.45 |
75032 | Mixed dentition treatment including incisor alignment (mandibular and/or maxillary) lateral arch expansion, including supply of appliances and all adjustments of appliances, removal of appliances and retention | 1815.80 |
75034 | Mixed dentition treatment—incisor alignment with or without lateral arch expansion using a removable appliance in the maxillary arch, including supply of all appliances, and associated adjustments and retention | 672.80 |
75039 | Permanent dentition treatment—single arch (mandibular or maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances and aligners—initial 3 months of active treatment | 611.20 |
75042 | Permanent dentition treatment—single arch (mandibular or maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances and aligners—each subsequent 3 months of active treatment (including all adjustments and maintenance and removal of the appliances) after the initial three months of active treatment for a maximum of a further 33 months | 228.45 |
75045 | Permanent dentition treatment—2 arch (mandibular and maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances or aligners—initial 3 months of active treatment | 1,223.50 |
75048 | Permanent dentition treatment—2 arch (mandibular and maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances or aligners—each subsequent 3 months of active treatment (including all adjustments and maintenance, and removal of the appliances) after the initial three months of active treatment for a maximum of a further 33 months | 313.75 |
75049 | Retention, fixed or removable, single arch (mandibular or maxillary)—supply of retainer and supervision of retention | 367.25 |
75050 | Retention, fixed or removable, 2‑arch (mandibular and maxillary)—supply of retainers and supervision of retention | 708.90 |
75051 | Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances | 1,088.20 |
75200 | Removal of tooth or tooth fragment (other than treatment to which item 75402 or 75405 applies) | 60.45 |
75203 | Removal of tooth or tooth fragment under general anaesthesia (H) | 90.70 |
75206 | Removal of each additional tooth or tooth fragment if provided in association with a service to which item 75200 or 75203 applies | 30.10 |
75400 | Surgical removal of erupted tooth | 181.35 |
75402 | Surgical removal of tooth, or tooth fragment requiring incision of soft tissue only | 179.25 |
75405 | Surgical removal of tooth, or tooth fragment requiring removal of bone, where the patient is referred by a referring dentist or medical practitioner | 229.20 |
75600 | Surgical exposure and packing of unerupted tooth | 255.40 |
75603 | Surgical exposure of unerupted tooth for the purpose of fitting a traction device or placement of a temporary anchorage device | 300.25 |
75606 | Surgical repositioning of unerupted tooth where the patient is referred by a referring dentist or medical practitioner | 300.25 |
75609 | Transplantation of tooth bud where the patient is referred by a referring dentist or medical practitioner | 448.20 |
75610 | Surgical procedure for intraoral implantation of an osseointegrated fixture and placement of transmucosal abutments where the patient is referred by a referring dentist or medical practitioner | 380.00 |
75618 | Fabrication and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome | 254.90 |
75621 | The fabrication and fitting of surgical splint or guide in conjunction with orthognathic surgical procedures and implant treatment, if provided in association with a service to which: (a) any item in the following series applies: (i) any of items 46150 to 46161 apply; or (ii) any of items 52342 to 52375 apply; or (b) item 52380 or 52382 applies; (c) item 75610 applies | 254.90 |
75800 | Attendance involving consultation, preventive treatment and prophylaxis, of not less than 30 minutes in duration for each attendance to a maximum of 3 attendances in any 12 month period (other than a service associated with a service to which item 75009, 75012, 75015 or 75023 applies) | 90.70 |
75802 | Fabrication and fitting of acrylic base partial denture, including retainers—1 to 4 teeth | 463.20 |
75815 | Fabrication and fitting of acrylic base partial denture, including retainers—5 to 9 teeth | 683.45 |
75818 | Fabrication and fitting of acrylic base partial denture or complete denture or overdenture, including retainers—10 to 12 teeth | 806.45 |
75820 | Fabrication and fitting of metal framework partial denture, including all components—1 to 4 teeth | 803.80 |
75833 | Fabrication and fitting of metal framework partial denture including all components—5 to 9 teeth | 1,164.95 |
75836 | Fabrication and fitting of metal framework partial denture or complete denture or overdenture including all components—10 to 12 teeth | 1,333.05 |
75842 | Adjustment of denture (other than a service associated with a service to which item 75802, 75815, 75818, 75820, 75833 or 75836 applies) | 44.85 |
75845 | Relining of denture by laboratory process and associated fitting | 224.15 |
75848 | Remodelling and fitting of denture of more than 4 teeth | 268.80 |
75851 | Repair to metal framework of denture—1 or more points | 134.45 |
75854 | Addition of a tooth or teeth to a denture to replace extracted tooth or teeth, including taking of necessary impression | 134.45 |
Schedule 2—Eligible cleft or craniofacial conditions
Table 9– Eligible cleft or craniofacial conditions |
1. Oral and/or facial clefting |
Limited to | Cleft lip, alveolus and/or palate |
Tessier facial cleft |
2. Congenital or hereditary craniofacial malformation, deformation or disruption |
Limited to | Achondroplasia |
Branchial arch disorders including: Hemifacial/craniofacial microsomia, Goldenhar syndrome, DiGeorge syndrome, Velocardiofacial syndrome, Auriculo‑condylar syndrome |
CHARGE syndrome |
Congenital hemifacial hyperplasia |
Congenital lymphatic and/or vascular malformations of the head & neck, cystic hygroma, Sturge‑Weber syndrome, excluding haemangiomas, birthmarks, and naevi. |
Craniofacial Neurofibromatosis Type 1 |
Craniometaphyseal dysplasia |
Congenital lymphatic and vascular malformations and segmental haemangiomas involving the jaws and associated soft tissues including cystic hygroma and Sturge‑Weber syndrome. |
Ectodermal dysplasia |
Hemifacial atrophy (Parry Romberg syndrome) |
Mandibulofacial dysostosis (Treacher Collins syndrome) |
Maxillonasal dysplasia (Binder syndrome) |
Oral‑facial digital syndrome Type 1 |
Osteogenesis imperfercta |
Pierre Robin sequence |
Rubinstein‑Taybi syndrome |
Shprintzen‑Goldberg syndrome |
Solitary median maxillary central incisor syndrome |
Stickler syndrome |
Syndromic craniosynostoses including: Apert, Crouzon, Pfeiffer, Saethre Chotzen, and Muenke syndromes |
Trichorhinophalangeal syndrome Type 1 |
3. Hereditary conditions presenting with the absence of 6 (six) or more permanent teeth, excluding 3rd molars |
4. Hereditary conditions where the presence of supernumerary teeth is a major feature |
Limited to | Cleidocranial dysplasia |
Gardner’s syndrome |
5. Development or Hereditary conditions affecting the formation of enamel and/or dentine of all teeth |
Limited to | Amelogenesis imperfecta |
Dentinogenesis imperfecta |
Regional odontodysplasia |
| | |
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.
Editorial changes
The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.
If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.
If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.
Endnote 2—Abbreviation key
ad = added or inserted | o = order(s) |
am = amended | Ord = Ordinance |
amdt = amendment | orig = original |
c = clause(s) | par = paragraph(s)/subparagraph(s) |
C[x] = Compilation No. x | /sub‑subparagraph(s) |
Ch = Chapter(s) | pres = present |
def = definition(s) | prev = previous |
Dict = Dictionary | (prev…) = previously |
disallowed = disallowed by Parliament | Pt = Part(s) |
Div = Division(s) | r = regulation(s)/rule(s) |
ed = editorial change | reloc = relocated |
exp = expires/expired or ceases/ceased to have | renum = renumbered |
effect | rep = repealed |
F = Federal Register of Legislation | rs = repealed and substituted |
gaz = gazette | s = section(s)/subsection(s) |
LA = Legislation Act 2003 | Sch = Schedule(s) |
LIA = Legislative Instruments Act 2003 | Sdiv = Subdivision(s) |
(md) = misdescribed amendment can be given | SLI = Select Legislative Instrument |
effect | SR = Statutory Rules |
(md not incorp) = misdescribed amendment | Sub‑Ch = Sub‑Chapter(s) |
cannot be given effect | SubPt = Subpart(s) |
mod = modified/modification | underlining = whole or part not |
No. = Number(s) | commenced or to be commenced |
Endnote 3—Legislation history
Name | Registration | Commencement | Application, saving and transitional provisions |
Health Insurance (Section 3C General Medical Services – Cleft and Craniofacial Services) Determination 2024 | 1 Feb 2024 (F2024L00110) | 1 Mar 2024 (s 2(1) item 1) | |
Health Insurance Legislation Amendment (Indexation) Determination 2024 | 21 May 2024 (F2024L00563) | Sch 1 (item 9): 1 July 2024 (s 2(1) item 1) | — |
Health Insurance Legislative Amendment (Hospital-Only Services) Determination 2025 | 3 Feb 2025 (F2025L00074) | Sch 1 (item 3): 1 Mar 2025 (s 2(1) item 1) | — |
Endnote 4—Amendment history
Provision affected | How affected |
s 2..................... | rep LA s 48D |
s 9..................... | ad F2024L00563 |
Schedule 1 | |
Schedule 1................ | am F2025L00074 |
Schedule 3................ | rep LA s 48C |