Provider eligibility for Child Dental Benefits Schedule (CDBS) in Medicare 011-41030040

To provide services under the CDBS, a dental practitioner must have general or specialist registration with the Dental Board of Australia.

A service or part of a service may be provided by an oral health therapist, dental hygienist, dental therapist or dental prosthetist on behalf of a dentist or dental specialist and must be billed under the dentist’s provider number.

Note:

• oral health therapists, dental hygienists and dental therapists can now register with the Services Australia for a Medicare provider number
• dental prosthetists can register for a Medicare provider number however; they cannot use their own provider number for Medicare billing
• when referring patients for diagnostic imaging, pathology tests or prescribing under Medicare for either, private, public and representative public dentists they must use their own Medicare provider number

Private practice dentists must have both:

• general or specialist registration with the Dental Board of Australia, and
• a valid provider number issued by the Services Australia for the practice location where the service is provided

Note: if a provider number is already issued, the dentist can use the existing provider number for that location as long as it is current.

Representative public dentist

A representative public dentist model exists for services provided within public sector clinics. This model has been agreed by the Department of Health and Aged Care, Services Australia and the state and territory health departments, and includes a nominated 'trusted source' who must confirm the representative public dentist.

Representative public dentists must bill the service against the representative dentist's provider number.

One or more representative public dentists can be nominated for each state and territory.

Representative public dentists must have both:

• general or specialist registration with the Dental Board of Australia, and
• a provider number for each public sector clinic location they are responsible for under the representative public dentist model

Note: enquiries and applications for provider numbers for representative public dentists must be directed to the Services Australia, Canberra Provider Eligibility and Accreditation.

Non representative public dentists

A dentist working in an eligible public sector clinic who is not the authorised representative public dentist must use the provider number of the representative public dentist for the location where they are providing the service.

Public dentist participation in the CDBS

The Department of Health and Aged Care, Services Australia and the state and territory health departments have agreed to separate provider registration and Medicare service billing arrangements for representative public dentists.

Representative public dentist participation in CDBS is contingent on the state and territory health departments maintaining their existing activity levels and expenditure on dental services as well as meeting certain other conditions. Access to CDBS is expected to be granted for a period of 3 years. The Department of Health and Aged Care can advise Services Australia to remove access to an individual public dentist clinic and/or representative public dentist.

Note: the Provider Eligibility and Accreditation Section will action advice received from the Department of Health and Aged Care.

Informed consent

Before performing services, a dental provider must obtain consent from a patient or their parent/guardian for the:

• proposed services, and
• associated costs for the proposed services

This consent can be obtained verbally but must be recorded on a patient consent form and include a signature from the child/teenager or parent/guardian for confirmation.

For:

• Private billing, a Non-Bulk Billing patient consent form must be completed on each day a service is provided
• Bulk billing, a Bulk Billing patient consent form only needs to be completed on the first day of service in the calendar year. Once the patient has signed the form, consent does not need to be documented again for future bulk billed services that year. Consent must be documented again on the first day the patient receives services in a subsequent year.

Note: for bulk billed services, an Informed Financial Consent - Bulk Billing Patient Consent Form is only required on the first visit in each calendar year. If the patient is seeing multiple dentists within a practice, 1 form is required to be completed per provider, not 1 form per practice. Consent must be documented again on the first day the patient receives services in a subsequent year.

The Resources page contains a link to the health professionals forms page on the Services Australia website, on which the Non-Bulk Billing patient consent form, the Bulk Billing patient consent form are located, and a link to the Department of Health and Aged Care Child Dental Benefits Schedule page, on which the Informed Financial Consent - Bulk Billing Patient Consent form can be found.

Record keeping

Dental providers must maintain adequate records for 4 years from the date of service including:

• patient consent form/s, and
• clinical notes (including noting the particular tooth or teeth a CDBS service relates to, where relevant)

Any other relevant document/s such as itemised accounts or receipts, verifying the service/s claimed were provided, should be retained.