Source: https://www.legislation.gov.au/Details/F2019C00599
Timestamp: 2019-08-23 11:33:53
Document Index: 771455645

Matched Legal Cases: ['art 1', 'art 2', 'art 3', 'art 1', 'art 2', 'art 3']

Health Insurance (Cleft Lip and Cleft Palate Services) Determination 2012
Details: F2019C00599
- F2019C00599
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
Health Insurance (Section 3C General Medical Services – Cleft Lip and Cleft Palate Services) Amendment Determination 2019 - F2019L00602
Includes amendments up to: F2019L00602
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).
5 Treatment of relevant services 5
6 Limitation on services 5
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
This Determination is the Health Insurance (Cleft Lip and Cleft Palate services) Determination 2012.
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.
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:
5 Treatment of relevant services
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:
(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
Part 1 Group C1 Orthodontic services and fees
Category 7 – Cleft Lip and Cleft Palate Services
Group C1 – Orthodontic Services
Professional attendance by an eligible orthodontist after the first professional attendance by the orthodontist in a single course of treatment (AO)
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;
Orthodontic radiography — orthopantomography (panoramic radiography), including any consultation on the same occasion (AOS) (AO)
Orthodontic radiography — anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings including any consultation on the same occasion (AOS) (AO)
Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings including any consultation on the same occasion (AOS) (AO)
Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography including any consultation on the same occasion (AOS) (AO)
Orthodontic radiography — hand‑wrist studies (including growth prediction) including any consultation on the same occasion (AOS) (AO)
Intraoral radiography — single area, periapical or bitewing film (AOS) (AO)
Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 1 appliance is used (AO)
Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 2 appliances are used (AO)
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)
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)
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)
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)
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)
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)
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)
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)
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)
Retention, fixed or removable, single arch (mandibular or maxillary) — supply of retainer and supervision of retention (AO)
Retention, fixed or removable, 2‑arch (mandibular and maxillary) — supply of retainers and supervision of retention (AO)
Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances (AO)
Part 2 Group C2 Oral and maxillofacial services and fees
Group C2 – Oral and Maxillofacial Services
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)
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)
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)
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)
Surgical procedure for fixation of trans‑mucosal abutment (second stage of osseointegrated implant), if the patient is referred by an eligible orthodontist (AOS)
Part 3 Group C3 General and prosthodontic services and fees
Group C3 – General and Prosthodontic Services
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)
Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD)
Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD)
Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD)
Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD)
Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD)
Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD)
Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD)
Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD)
Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD)
Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD)
Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD)
Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD)
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)
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)
Relining of partial denture by laboratory process and associated fitting (AD)
Remodelling and fitting of partial denture of more than 4 teeth (AD)
Repair to cast metal base of partial denture — 1 or more points (AD)
Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD)
31 Oct 2013 (F2012L02113)
Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013
23 Oct 2013 (F2013L01825)
Health Insurance (Section 3C General Medical Services – Cleft Lip and Cleft Palate Services) Amendment Determination 2019
10 Apr 2019 (F2019L00602)
rep F2013L01825
am F2019L00602