Practitioners who provide treatment under the CDBS should be aware that a schedule with a restricted range of dental services applies. This is separate to the ADA Australian Schedule of Dental Services and Glossary.
When billing and claiming for services under the CDBS, practitioners are required to correctly identify the services they have conducted and match the service with the correct identifying item number as per the CDBS schedule.
CDBS Item Numbers
Applicable CDBS item numbers and associated descriptors, together with CDBS-specific restrictions and limitations are set out in the schedule. The maximum benefits that apply are also listed.
The Dental Benefits Act 2008 requires that a service must be ‘clinically relevant’ for a dental benefit to be payable. This means it is important, especially for Medicare (and Private Health Insurers) to record details of the presentation and the treatment. For example, when claiming 88114 details such as the location and extent of plaque/calculus and the actual method of removal need to be recorded.
CDBS Item Numbers 88111 and 88114 – appropriate use
There are some notable differences between the CDBS and the ADA Schedule. You need to read the CDBS carefully to ensure you use the correct item number that coincides with the service you have provided and that you have understood any restrictions or limitations that apply to providing that service. For example, if you simply remove plaque and/or stain from all teeth, then you should submit a claim for item number 88111. However, if you remove calculus from any number of teeth and also perform a dental prophylaxis, then you might choose to submit a claim under item number 88114 or 88111 at your discretion. Click here for further CDBS resources. https://www.health.gov.au/resources/collections/cdbs-resources-for-dental-service-providers;
If you have received hardcopy notification of an audit from the Department of Health (Medicare) please scan to a pdf or take photos on your phone and email to advisory@adansw.com.au. For any queries regarding the use of item numbers please contact the Advisory Services team.
If you require more information, please do not hesitate to email Advisory Services at advisory@adansw.com.au or call 8436 9944.
