Cleft Lip and Cleft Palate Scheme

Medical benefits to help with treatment costs for cleft lip and cleft palate conditions.

Eligibility basics

  • you’re enrolled in Medicare
  • you’re under 28
  • before you turned 22 a doctor diagnosed you with a cleft lip, cleft palate or similar condition and you started treatment

Who can get treatment under the scheme

You can get treatment under the scheme if:

  • you’re enrolled in Medicare
  • a health professional certified you with a cleft lip, cleft palate or other eligible condition before you turned 22 years of age - you can ask your health professional if your condition is eligible under the scheme
  • your treatment by an approved health professional started before you turned 22, and
  • you’re under 28 when you get treatment

Age limits

You must start your treatment under the scheme before you turn 22.

Your treatment under the scheme will stop when you turn 28.

What may be different

If you're over 28 and need repairs to reconstructive work you had under the scheme, your treating health professional can apply for approval for additional treatment. If we:

  • approve the repairs, you can claim Medicare benefits for the treatment cost
  • don’t approve the repairs, Medicare won’t cover them and you’ll need to pay for the treatment cost yourself

Treatment the scheme covers

The dental treatment you can get under the scheme includes:

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

You can get Medicare benefits for your treatment under the scheme if it’s done by an orthodontist, oral and maxillofacial surgeon or dentist we recognise.

Before you start treatment, ask your health professional if they can do your treatment under the scheme. If they can’t, you won’t get Medicare benefits for your treatment and you may need to pay.

Page last updated: 2 November 2017