Child Dental Benefits Schedule for health professionals

Information for dental practitioners who provide dental services through the Child Dental Benefits Schedule.

About

About the Child Dental Benefits Schedule

The Child Dental Benefits Schedule (CDBS) provides basic dental services to children. Dental services are capped at $1,000 over 2 consecutive calendar years.

Dental services include:

  • examinations
  • X-rays
  • cleaning
  • fissure sealing
  • fillings
  • root canals
  • extractions, and
  • partial dentures

The CDBS does not cover orthodontic, cosmetic dental work, or dental services provided in hospital.

There are some restrictions for dental services. These are listed in the Guide to the Child Dental Benefits Schedule on the Department of Health’s website.

Dental practitioner requirements for the Child Dental Benefits Schedule

It is voluntary to participate in the Child Dental Benefits Schedule.

To provide services, you must be a dentist or dental specialist holding a general or specialist registration with the Dental Board of Australia.

Services, or part services, may be provided on behalf of a dentist or dental specialist by the following types of dental practitioners who hold general registration with the Dental Board of Australia:

  • dental hygienists
  • dental therapists
  • oral health therapists
  • dental prosthetists

If a dental practitioner is performing the service on behalf of a dentist or dental specialist, it must be performed in accordance with accepted dental practice. This includes any supervision requirements.

There are separate administrative arrangements for dentists working in public dental clinics. You should contact your state or territory government for further information.

Before performing any services, you must obtain informed financial consent for services and costs from your patient, or their parent or guardian by signing an Informed Financial Consent form.

Services covered by the Child Dental Benefits Schedule

Dental services covered by the Child Dental Benefits Schedule include:

  • examinations
  • x-rays
  • cleaning
  • fissure sealing
  • fillings
  • root canals
  • extractions
  • partial dentures
The claiming restrictions are outlined in the Guide to the Child Dental Benefits Schedule on the Department of Health’s website.

Patient eligibility for the Child Dental Benefits Schedule

To be eligible for the Child Dental Benefits Schedule, your patient must:

  • be aged 2 to 17 years for at least 1 day of the calendar year
  • be eligible for Medicare
  • receive, or be part of a family receiving, certain Australian Government payments

We assess eligibility at the beginning of each calendar year and it's valid for the entire year. Children who become eligible later in the calendar year will have their eligibility backdated to begin from 1 January of that calendar year.

Before you provide any services check your patient's eligibility and balance. You can do this through Health Professional Online Services (HPOS) or by calling us.

Informed financial consent for Child Dental Benefits Schedule services

You must discuss and obtain consent from the patient, or their parent or guardian, for basic dental services and advise them of the associated costs. This must be completed on the day in writing before the end of the visit.

How you bill your patient will determine which consent form they must complete.

For privately billed, or non-bulk billed services, you must have your patient or their parent or guardian provide consent at each visit. You can do this by getting them to sign the Department of Health’s Informed Financial Consent - Non-Bulk Billing Patient Consent Form [pdf, 289kb].

For bulk billed services, your patient or their parent or guardian only has to provide consent on the first visit each year. If your patient is seeing multiple dentists within a single practice, they must complete a form for each dentist they visit. You can use the Department of Health’s Informed Financial Consent - Bulk Billing Patient Consent Form [pdf, 246kb].

Record keeping for the Child Dental Benefits Schedule

You must maintain adequate records for audit purposes for 4 years from the date of service. You must keep:

  • patient consent forms, the type of form depends on how you bill your patient
  • clinical notes including notes about the particular tooth or teeth a CDBS service relates to, and
  • any other relevant documents, such as itemised accounts or receipts showing that the claimed services were provided

Claiming

Claiming for the Child Dental Benefits Schedule

Services can only be claimed using your dentist or dental specialist's Medicare provider number.

You can either bulk bill or provide your patient an account for your services. Services must be fully completed before you bill your patient or submit a bulk billing claim. Service restrictions are outlined in the Guide to the Child Dental Benefits Schedule on the Department of Health’s website.

Bulk billing your patient

For bulk billed services you must have your patient complete:

The forms require the:

  • patient's name
  • date of the service
  • item number in the Dental Benefits Schedule that corresponds to the service
  • your name and provider number, and
  • amount of the dental benefit being assigned to you

Issuing an account to your patient

If you privately bill with an account, your patient can claim their Medicare benefit electronically at your surgery if you offer Medicare Online or Medicare Easyclaim as a claiming option. If you don’t, your patient can claim their benefit through us.

Before we will pay your patient, the account or receipt you issue must include:

  • your patient's name
  • date of service
  • item number in the Dental Benefits Schedule that corresponds to the service
  • your name and provider number, and
  • amount charged for the service, total amount paid and any amount outstanding in relation to the service

A service is complete once all aspects of the service have been provided.

You have claiming options as a health professional.

Electronic claiming channels, including Medicare Online and Medicare Easyclaim provide you with a convenient and quick way to lodge claims directly with us from your surgery.

You can also submit claims manually, but these will take longer to process.

Item numbers for your Child Dental Benefits Schedule claim

Access the Child Dental Benefit Schedule item numbers in the Dental Benefits Schedule (DBS) items 88011 – 88943, for your claims on the Department of Health’s website.

Provider number for the Child Dental Benefits Schedule

You must have general or specialist registration, 112 or 106, with a Medicare provider number, associated with specialty code 107.

If you do not have an existing provider number, you will need to complete an Application for an initial Medicare provider/registration number for a Dentist, Dental Specialist or Dental Prosthetist form (HW017).

When your application is successfully processed, we will confirm your provider number by mail. Your provider number is given to you for the location in your application.

If you change your location, you will need to complete an Application for an additional location Medicare provider/registration number form (1413-2).

Resources

Child Dental Benefits Schedule legislation

The payment of dental benefits is regulated by the Dental Benefits Act 2008 and the Dental Benefit Rules. You can access and read these legislative instruments on ComLaw website.

Promotional materials for your patients about the Child Dental Benefits Schedule

We have developed a self-print poster to promote the CDBS in your practice. You can also print the content on our website for your customers. Our print package allows you to tailor information to your patient. You can select the information to include and it will tell your patient where more information is available. You can also direct your patient to our website. Your patient can read more about the CDBS on eligibility and how to make a claim.

Educational services for the Child Dental Benefits Schedule

Our CDBS for Dental Providers eLearning module provides an overview of your claiming and servicing requirements.

We also have other education services for health professionals including Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and provider claiming. Read more about education services for health professionals.

This information was printed from humanservices.gov.au It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.