Child Dental Benefits Schedule for health professionals

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

The CDBS cap is now $1000. We'll reassess bulk billed claims rejected because of the $700 cap and repay you. You don't need to do anything.

About

About the schedule

The Child Dental Benefits Schedule (CDBS) provides basic dental services to children aged between 2 and 17 years.

Under the CDBS, we cap dental services at $1,000 over 2 consecutive calendar years.

The 2-year cap period starts when a child or teenager first gets an eligible dental service.

Services covered

Dental services covered by the CDBS include:

  • examinations
  • x-rays
  • cleaning
  • fissure sealing
  • fillings
  • root canals
  • extractions
  • partial dentures.

The CDBS doesn't cover orthodontic, cosmetic dental work or dental services provided in hospital.

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

Patient eligibility

To be eligible for the CDBS, your patient must:

  • be aged 2 to 17 years for at least 1 day of the calendar year
  • be eligible for Medicare on the day of service
  • get, or be part of a family getting, 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. It will 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.

Dental practitioner requirements

It's voluntary to participate in the CDBS.

To provide services, you must be recognised to provide dental services under Medicare.

Another practitioner can provide services on behalf of a dentist or dental specialist. The person providing the services must hold general registration with the Dental Board of Australia. They can be:

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

The dental practitioner must perform all services in accordance with accepted dental practice. This includes any supervision requirements.

There are separate administrative arrangements for dentists working in public dental clinics. Contact your state or territory government for more information.

Before performing any services, you must:

  • confirm the patient is eligible
  • confirm the patient’s balance amount through Health Professional Online Services (HPOS) or by calling us
  • discuss the patient’s treatment, costs and if there are any item restrictions
  • get consent from the patient, or their parent or guardian using the informed financial consent form from the Department of Health’s website.

Informed financial consent for schedule services

You must discuss the treatment and costs for basic dental services with your patient before providing the service. If the patient, or their parent or guardian, agrees to the services and cost, they must sign the consent form.

How you bill your patient determines the consent form they must complete. The forms are on the Department of Health’s website.

For privately billed services, the patient, or their parent or guardian, must sign the Informed Financial Consent - non-bulk billing patient consent form at each visit.

For bulk billed services, your patient, or their parent or guardian, must sign the Informed Financial Consent - bulk billing patient consent form on the first visit each year. If your patient is seeing multiple dentists in a single practice, they must complete a form for each dentist.

Translated Informed Financial Consent Forms are available on the Department of Health's website.

Record keeping

You must keep 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
  • any other relevant documents, such as itemised accounts or receipts showing you provided the claimed services.

Claiming

Claiming services

You can only claim services using your dentist or dental specialist's Medicare provider number. You can bulk bill or provide your patient an account for your services. You must complete services before you bill your patient or submit a bulk billing claim. Service restrictions are in the Guide to the Child Dental Benefits Schedule on the Department of Health’s website.

Read more about online options for health professionals.

Electronic claiming channels are a convenient and quick way to lodge claims directly with us from your surgery. They include Medicare Online and Medicare Easyclaim.

You can also submit your Medicare bulk bill claims electronically using either:

  • your practice software
  • Medicare Bulk Bill Webclaim.

You can access Medicare Bulk Bill Webclaim using Health Professional Online Services (HPOS).

If you don’t have HPOS access, you need to apply for a Provider Digital Access (PRODA) first.

If you’re unable to submit an electronic claim, you can submit claims manually, but these take longer to process.

You can order approved bulk billing Medicare claim forms using the Medicare stationery order form.

Bulk billing your patient

You must complete the assignment of benefit form in full and include:

  • your patient's name
  • the date of the service
  • the Dental Benefits Schedule item number that corresponds to the service
  • your name and provider number
  • the amount of the dental benefit assigned to you
  • your patient's or their parent or guardian's signature.

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. If you don’t offer electronic claiming options, your patient can claim their benefit through us.

For us to pay your patient, the account or receipt you issue must include:

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

A service is complete once you've provided all parts of the service.

Item numbers for your claim

Use the Child Dental Benefit Schedule item numbers on the Department of Health's website for your claims. They are Dental Benefits Schedule items 88011-88943.

Provider number

You need the Medicare provider number associated with specialty code 107.

You must have both:

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

Read more about provider numbers and Medicare benefits.

Resources

Child Dental Benefits Schedule legislation

The Dental Benefits Act 2008 and the Dental Benefit Rules regulate the payment of dental benefits. You can access and read these legislative instruments on the Federal Register of Legislation website.

Promote the CDBS in your practice today

You can print and display this 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.

Page last updated: 2 November 2018