Chapter 21: Medicare for Orthodontics and Related Dental Care

The costs of orthodontic and some dental treatment for patients who have a cleft condition and are registered with the Commonwealth Health Insurance Commission are now met, in part, by Medicare. All the Medicare rebates for such treatment are clearly set out in the book, "Medicare Benefits for the Treatment of Cleft Lip and Cleft Palate Conditions". (By Calling 1800 020 103)

Currently Medicare will refund 85% of the schedule fee, and the parents (or patient under 28 years of age) pay the difference. If your orthodontist or dental practitioner charges more than the schedule fee, you will have to pay this extra sum. To be eligible for Medicare rebate, your orthodontist and/or dentist must be registered to treat patients with cleft conditions. The patient must also be registered with Health Insurance Commission in Canberra and be issued with a plastic identification card and registration number.

This card is sent to the patient on receipt of a special certificate, signed by the patient's specialist (plastic surgeon or orthodontist) confirming the cleft condition. This certificate can be completed at the first consultation, or later when commencing dental or orthodontic visits. Most Cleft Palate Clinics have a supply of these certificates for completion by the specialist. Your orthodontist and plastic surgeon should also have a supply of these certificates. Ask your specialist or Cleft Palate Clinic for more information.

It is worth noting that up to three (3) consultations in any 12 month period with a dental practitioner may be claimed on Medicare. Preventative treatment including dietary advice, oral hygiene and fluoride treatment are part of this service.

In completing the Medicare claim form make sure that it is correctly filled in, that the account shows the appropriate coded reference numbers for the various orthodontic and/or related dental procedures, that the patient has a cleft condition and quote the registration number from the Commonwealth identification card.

Health Insurance Commission
PO Box 9822
Perth WA 6001
1300 652 492

Further Information

To obtain further information on "Cleft Lip and Palate: A Parent's Guide", please contact Belinda Liston:

Belina Liston
Cleft Palate Clinic Coordinator
The Cleft Palate Clinic
The Children's Hospital at Westmead
Locked Bag 4001
WESTMEAD NSW 2145
AUSTRALIA
T: + 61 2 9845 2079
F: + 61 2 9845 2078
E: BelindaS4@chw.edu.au