Cleft and craniofacial conditions for health professionals

Eligible patients can access Medicare benefits for when treating for Cleft and Craniofacial conditions.

Health professional eligibility

Eligible health professionals include:

  • orthodontists
  • oral and maxillofacial surgeons
  • dentists
  • paediatric dentists
  • prosthodontists.

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

Category 7 of the Medicare Benefits Schedule (MBS) covers Group C1 - Cleft and Craniofacial Services.

For information on available services, visit the MBS Online website.

Patient eligibility

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

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

Some Medicare items require a referral.

Cleft or Craniofacial patient certification

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 text indicating 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 Department of Health and Aged Care’s MBS Online website.

Page last updated: 1 March 2024.
QC 23011