Cleft and craniofacial conditions

Medicare benefits to help with treatment costs for cleft and craniofacial conditions.

To get this you must be:

  • enrolled in Medicare
  • diagnosed with an eligible cleft and craniofacial condition by a health professional.

Your cleft or craniofacial treatment must be approved by the Department of Health and Aged Care if you were treated before 1 November 2023 and are aged 28 and over.

What treatment is covered

You can get certain dental treatment services for a cleft or craniofacial condition.

This includes any of these:

  • some orthodontic work
  • simple and surgical extraction of teeth
  • some general and prosthodontic services by your family dentist
  • oral and maxillofacial services.

You can get Medicare benefits for your treatment if it’s done by:

  • an orthodontist
  • an oral and maxillofacial surgeon
  • a dentist.

They can also diagnose you with eligible cleft or craniofacial conditions.

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

Before you start treatment, ask your health professional if they can do your treatment under the Medicare Benefits Schedule (MBS) and if there’ll be any out-of-pocket expenses. If they can’t, you won’t get Medicare benefits for your treatment and may need to pay the full amount.

Page last updated: 19 December 2023.
QC 21961