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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.

Dental services are capped at $1000 over 2 consecutive calendar years.

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

Dental services include:

  • examinations
  • X-rays
  • cleaning
  • fissure sealing
  • fillings
  • root canals
  • extractions, and
  • 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 listed in the Guide to the Child Dental Benefits Schedule on the Department of Health’s website.

Dental practitioner requirements

It's voluntary to participate in the CDBS.

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. Contact your state or territory government for more information.

Before performing any services, you must get a signed Informed Financial Consent form for services and costs from your patient, or their parent or guardian.

Services covered

Dental services covered by the CDBS 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

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 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 schedule services

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

How you bill your patient determines 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 Informed Financial Consent - Non-Bulk Billing Patient Consent Form on the Department of Health website.

For bulk billed services, your patient or their parent or guardian still need to provide consent at each visit. You only need to get them to sign a 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 they visit. Use the Informed Financial Consent - Bulk Billing Patient Consent Form on the Department of Health website.

Translated Informed Financial Consent Forms are available on the Department of Health 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, and
  • any other relevant documents, such as itemised accounts or receipts showing the claimed services were provided

Claiming

Claiming services

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

Read more about 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 your Medicare bulk bill claims electronically using your practice software or through Medicare Bulk Bill Webclaim. Medicare Bulk Bill Webclaim can be accessed using Health Professional Online Services (HPOS).

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

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

Approved bulk billing Medicare claim forms can be ordered using the Medicare stationery order form.

Bulk billing your patient

The assignment of benefit form must be completed in full and include:

  • patient's name
  • date of the service
  • the Dental Benefits Schedule item number that corresponds to the service
  • your name and provider number, and
  • amount of the dental benefit assigned to you
  • your patient's (or their parent/guardian/responsible person) 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 as a claiming option. If you don’t, your patient can claim their benefit through us.

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

  • your patient's name
  • date of service
  • the Dental Benefits Schedule item number 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 for the service

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

Item numbers for your 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

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

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

If you don't have an existing provider number, you need to complete an Application for an initial Medicare provider number for a dentist, dental specialist or dental prosthetist form.

When your application is successfully processed, we'll 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 need to complete an Application for an additional location Medicare provider number for a medical practitioner form.

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 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: 27 August 2017