Claim for cleft and craniofacial condition services

Eligible patients can access Medicare benefits for treatment of cleft and craniofacial conditions.

Eligible health professionals include:

  • orthodontists
  • oral and maxillofacial surgeons
  • dentists.

You must be registered with us for cleft and craniofacial services to attract Medicare benefits. You can read how to start with Medicare.

Category 7 of the Medicare Benefits Schedule (MBS) covers all of the following:

  • Group C1 - Orthodontic services.
  • Group C2 - Oral and maxillofacial surgical services.
  • Group C3 - General and prosthodontic services.

For information on cleft and craniofacial services, visit the MBS Online website.

To be eligible for treatment, your patient must meet the following criteria:

  • be enrolled in Medicare
  • be certified by a health professional as having a cleft lip, a cleft palate or another eligible craniofacial condition.

Some Medicare items need a referral. For example, oral and maxillofacial service items need a referral from an orthodontist.

When providing treatment, you must certify in your claims that your patient meets all of the eligibility requirements of a patient with a cleft or craniofacial condition.

You’ll need to include the text ‘certified dental patient’ on the patient’s account or in the text field of a Medicare claim for benefits.

For information on eligible conditions, visit the MBS Online website.

Page last updated: 15 June 2024.
QC 71017