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Medicare dental programs

Medicare Teen Dental Plan

The Medicare Teen Dental Plan closed on 31 December 2013.

From 1 January 2014, the Medicare Teen Dental Plan will be replaced by the Child Dental Benefits Schedule.

Child Dental Benefits Schedule

Dental providers that hold general or specialist registration with the Dental Board of Australia can provide services under the Child Dental Benefits Schedule (CDBS). The services may only be billed by a dentist or dental specialist (either a private provider or a representative public dentist) with a current Medicare provider number.

Services or part of a service may also be provided on behalf of a dentist or dental specialist by another dental practitioner. These services may be provided by dental hygienists, dental therapists, oral health therapists and dental prosthetists.

  • The CDBS provides eligible children with benefits for basic dental services, capped at $1,000 over two consecutive calendar years. A child is eligible for the CDBS if he or she is aged between 2–17 years for at least one day of the calendar year and
  • receive, or their family, partner, guardian or carer receives, certain government payments for at least one day of the calendar year, and
  • are eligible for Medicare.

Services that receive a benefit under the CDBS include examinations, x-rays, cleaning, fissure sealing, fillings, root canals, extractions, and partial dentures. Many of these services have claiming restrictions.

Benefits are not available for orthodontic or cosmetic dental work and cannot be paid for any services provided in a hospital.

Providing services under the Child Dental Benefits Schedule

  • Before starting a consultation, you should check your patient’s CDBS eligibility and balance. You can do this through Health Professional Online Services (HPOS) or by calling 132 150. When calling, you will need to enter your 6 digit provider number. If required, please insert zeros at the beginning to make up a total of 6 digits. To access HPOS you need a valid Medicare Public Key Infrastructure (PKI) certificate. Find out more about HPOS.
  • Before providing services, you must discuss and obtain consent from the patient or their parent/guardian to the basic dental services needed, and the costs associated with the services. Consent to all services and costs must be documented in writing before the end of the visit
  • For privately billed services, the patient or their parent/guardian will need to document their consent by signing the relevant patient consent form - Informed Financial Consent – Non-Bulk Billing Patient Consent FormExternal link - at each visit. For bulk billed services, the relevant patient consent form - Informed Financial Consent – Bulk Billing Patient Consent FormExternal link - is only required on the first visit in each calendar year

Claiming services under the Child Dental Benefits Schedule

Submit your claim through your usual Medicare claiming process. Find out more about electronic claiming and how to register for online business.

A service must be fully completed before you bill the patient or submit a bulk billing claim.

Record keeping

Dental providers must maintain adequate records for 4 years from the date of service including:

  • patient consent forms, and
  • clinical notes (including noting the particular tooth or teeth a CDBS service relates to, where relevant)

You should also keep any other relevant documents such as itemised accounts or receipts verifying the services claimed were provided.

Forms for dental providers

For application and claim forms, go to Medicare forms for dental providers.

Resources for dental providers

We have a number of resources to support dental providers under the CDBS.

Provider toolkit materials

Refer to the CDBS Quick Reference Guide [PDF, 104Kb]PDF reader required for an overview of the CDBS and the claiming and servicing requirements.

Refer to the HPOS fact sheet [PDF, 84Kb]PDF reader required for dentists for an overview of HPOS and how you can use it to check a patient’s CDBS eligibility and available balance.

Complete our eLearning program for an overview of the claiming and servicing requirements under the CDBS. It focuses on the conditions and obligations including eligibility, informed consent and claiming requirements. 

A Guide to the Child Dental Benefits ScheduleExternal link produced by the Department of Health, explains program requirements and the list of eligible services, benefits and restrictions for each service. The Guide was updated on 6 December 2013 to include the Dental Benefits Schedule and changes to the description of sedation services.

The Department of Human Services conducted a mail out to eligible dental providers in November 2013. The letter [PDF, 171Kb]PDF reader required provided dentists with information on the CDBS.

More information

For more information on the CDBS, go to the Department of HealthExternal link website.

Information on the Dental Benefits Rules 2013 is available on the ComLawExternal link website.

Some documents on this page may require the free Adobe PDF reader.

Last updated: 29 April, 2014