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.