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BASED ON A USTRALIAN S CHEDULE OF D ENTAL S ERVICES AND G LOSSARY , 9 TH E DITION

Fee Schedule Update
Changes since the Fee Schedule of Dental Services for Dental Prosthetists Effective 1 November
2013 are listed below.
New Processes for items with quantity and/or time limit restrictions
If there is a clinical assessed need to provide dental services outside of the time and quantity limits as listed in this fee schedule, dental prosthetists will no longer be required to contact DVA for prior financial authorisation.
If dental services are provided outside of the limits, treatment must be based on assessed clinical need. It is important providers document the clinical reasons for treatment provision to DVA entitled persons if provided outside of the limits.
Lost or broken dentures
For the replacement of dentures that are lost or broken beyond repair, a statutory declaration from the patient must be provided and stored for audit purposes.
Compliance
DVA is placing greater emphasis on the existing compliance model for the provision of dental services. DVA will maintain its commitment to working with service providers to maximise voluntary compliance.
DVA has compliance monitoring systems which monitor the servicing and claiming patterns of health care providers. This information assists DVA to establish internal benchmarks, the current utilisation and projected future delivery of services.
Changes to holders of Repatriation Health Card - For Specific Conditions (White Card)

For treatment provided under the Veterans’ Entitlements Act 1986 (VEA) and the Military
Rehabilitation and Compensation Act 2004 (MRCA)
Dental providers are no longer required to contact DVA for prior financial authorisation of treatment for White Card holders where the service is related to the White Card holders accepted condition(s) unless otherwise specified in this fee schedule.
Further information
Website: http://www.dva.gov.au/service_providers/dental_allied/dental/Pages/dental.aspx
Or
Medical & Allied Health section on:
Non-metropolitan callers:
Metropolitan callers:
1800 550 457
1300 550 457
(Select Option 3, then Option 1)
(Select Option 3, then Option 1)
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
“FBN” means Fee By Negotiation.
_______________________________________________________________________________
National legislation:
Department of Veterans’ Affairs (DVA) will only pay for services provided by dental prosthetists where the provision of the service complies with National legislation.
Provision of dentures for radiation therapy patients:
A patient with a history of oral pathology needs to have a consultation with a dentist or specialist.
ADDRESS AND CONTACT NUMBERS FOR
THE DEPARTMENT OF VETERANS’ AFFAIRS (DVA)
Further information on dental services may be obtained from DVA. The contact numbers for health care providers requiring further information or prior financial authorisation are listed below:
Non-metropolitan callers:
Metropolitan callers:
1800 550 457
1300 550 457
(Select Option 3, then Option 1)
(Select Option 3, then Option 1)
DVA fax number for prior financial authorisation: (08) 8290 0422 (for all States & Territories)
Postal address (for all States & Territories): Medical & Allied Health Section
ADELAIDE SA 5001 http://www.dva.gov.au/service_providers/dental_allied/Pages/index.aspx.
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Claiming for payment of services
Department of Human Services (DHS) processes claims for health care providers on behalf of DVA.
Postal address for claims: Veterans’ Affairs Processing (VAP)
All claim enquiries telephone:
ADELAIDE SA 5001
1300 550 017
Dental Claim Forms
D919 - Dental Report and Voucher
D986 - Dental Request
D1217 - Claim for Treatment Services
P02098D - Fee Schedule of Dental Services for Dental Prosthetists
Ordering forms online is quick and simple and will ensure prompt delivery. To place your order online go to: www.dva.gov.au/service_providers/Pages/Forms.aspx
or
Tel: 1800 155 355
Fax: 1800 671 670
DVA provider fillable and printable health care claim forms & vouchers are available from the DVA website.
DVA provider health care claim forms and vouchers are available directly from the DVA website.
These forms are able to be filled electronically, saved and printed for manual claiming.
Simply go to: www.dva.gov.au/service_providers/Pages/Forms.aspx
and simply click on the relevant form number, this will take you directly to the required form for electronic completion which can then be saved and printed for manual claiming.
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EXAMINATIONS & DIAGNOSTIC SERVICES
D ESCRIPTION
Initial denture examination
Consultation
A typed letter of referral.
Written report (not elsewhere included)
Diagnostic model – per model
I TEM
T011
T014
T018
T019
T071
P RIOR
A PPROVAL
No
Yes
Yes
No
Yes
F EE
$
(E XCL .
GST)
S PECIAL
R EMARKS
48.20 Limit of one (1) per provider every two years after previous 011.
Limit applies to the same provider.
38.90 When specifically requested by
DVA or when required in order to obtain DVA approval for a course of treatment.
Subject to GST.
43.00 Claimable only when specifically requested by DVA. Must be kept on patient’s file.
Subject to GST.
10.10 Limit of one (1) per provider per
12 month period. A copy of this referral must be retained by provider.
55.20 On request from DVA only.
Subject to GST.
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DENTURES AND DENTURE COMPONENTS
Note 1: DVA will pay for dentures every six (6) years and a reline every two (2) years. DVA will not pay for a new denture if provided within twelve months of a reline of an existing denture. The number of teeth for each individual partial denture should be specified for each claim.
If a patient has been assessed as requiring new dentures/relines outside of the above limits, providers are no longer required to contact DVA for prior financial authorisation. If treatment is provided outside of the above limits, providers must provide clinical justification to DVA if requested.
D ESCRIPTION
Complete maxillary denture
Complete mandibular denture
Metal palate or plate
I TEM
P RIOR
A PPROVAL
F EE
$
(E XCL .
GST)
T711 See Note 1
T716
S PECIAL
R EMARKS
No As per lab invoice
Additional to item 711, 712 or 719.
Laboratory casting invoice required.
Maximum amount payable $430.55
Complete maxillary and mandibular dentures
Partial maxillary denture – resin base
– one tooth
– two teeth
– three teeth
– four teeth
– five to nine teeth
inclusive
– ten to twelve teeth
inclusive
Partial mandibular denture – resin base
– one tooth
– two teeth
– three teeth
– four teeth
– five to nine teeth
inclusive
– ten to twelve teeth
inclusive
T721
T722
No
No
366.25
418.25
489.45
550.05
651.15
752.75
See Note 1
366.25
418.25
489.45
550.05
651.15
752.75
See Note 1
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DENTURES AND DENTURE COMPONENTS (Cont.)
D ESCRIPTION I TEM
P RIOR
A PPROVAL
F EE
$
(E XCL .
GST)
T727 No
825.75
905.20
987.05
1017.90
1171.85
1292.60
See Note 1
S PECIAL
R EMARKS
Partial maxillary denture - cast metal framework
– one tooth
– two teeth
– three teeth
– four teeth
– five to nine teeth
inclusive
– ten to twelve teeth
inclusive
Partial mandibular denture – cast metal framework
– one tooth
– two teeth
– three teeth
– four teeth
– five to nine teeth
inclusive
– ten to twelve teeth
inclusive
Provision of casting
T728 No
825.75
905.20
987.05
1017.90
1171.85
1292.60
See Note 1
Retainer – per tooth
Occlusal rest
Immediate tooth replacement – per tooth
Resilient lining
T732
T736 No 8.25
T737 No
Wrought bar
T730
T731
T738
No As per lab invoice amount
No
Invoice is not submitted with claim, but should be retained by provider. Fee inclusive of clasps, retainers, occlusal rests, overlays and backings. Maximum amount payable $738.00
40.25 Additional to items 721 and 722.
No 19.65 Additional to items 721 and 722.
No
173.10 DVA will pay for item 737 with a new denture or items 737 and 743 together for an existing complete denture; and items 737 and 744 for an existing partial denture.
161.30
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DENTURE MAINTENANCE
Note 2: A fee will not be paid for:
1. adjustment(s) to full or partial dentures within twelve (12) months following provision or relining; or
2. reline(s) or remodel(s) to each upper or lower denture within two (2) years following provision or relining (except for immediate dentures which can be relined once within two years of their provision
– please specify immediate denture reline on the claim form).
Upper or lower denture must be specified for each claim.
If a patient has been assessed as requiring adjustments or relines outside of the above limits, providers are no longer required to contact DVA for prior financial authorisation.
If treatment is provided outside of the above limits, providers must provide clinical justification to DVA if requested.
D ESCRIPTION I TEM
P RIOR
A PPROVAL
F EE
$
(E XCL .
GST)
S PECIAL
R EMARKS
Adjustment of preexisting denture
Relining
- complete denture
- processed
Relining
- partial denture
- processed
Remodelling
- complete denture
Remodelling
- partial denture
Relining
- complete denture
- direct
T741 No 47.80
T745 Yes
T746 Yes
FBN
FBN
See Note 2
For soft relines, use items 743 and 737.
For soft relines, use items 744 and 737.
See Note 2
See Note 2
Limit of one (1) per denture every two years.
Chair-side only. Either hard or soft material.
Not to be used for temporary materials i.e. tissue conditioners.
Relining
- partial denture
- direct
Not to be used for temporary materials i.e. tissue conditioners.
Cleaning and polishing T753 No 38.80 See Note 2 of pre-existing denture
Limit of one (1) per two year period per denture.
Subject to GST.
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DENTURE REPAIRS
Note 3: Item 767 to be claimed for ANY second and subsequent reattachment/repair/replacement items performed on the SAME denture on the same day. UPR or LWR must be specified for each claim. If treatment is provided outside of the limits as listed in the Special Remarks providers must provide clinical justification to DVA if requested.
Reattaching preexisting tooth or clasp to denture
Replacing clasp on denture
I
TEM
P RIOR
A PPROVAL
T761 and
T482
T762
Repairing broken base T763 of a complete denture
D
ESCRIPTION and
T484
Repairing broken base T764 of a partial denture and
T485
No
No
No
No
No
No
No
No
F EE
$
(E XCL .
GST)
S
PECIAL
R EMARKS
34.80 Both items must be claimed.
97.35
761 to be claimed for GST-free component of service .
482 (labour, laboratory costs) to be claimed for GST-able component of service.
Limit of one (1) per day per denture.
137.90 Limit of one (1) per day per denture.
GST free.
34.80 Both items must be claimed.
763 to be claimed for GST-free component of service.
97.35
484 (labour, laboratory costs) to be claimed for GST-able component of service.
Limit of one (1) per day per denture.
34.80 Both items must be claimed.
97.35
764 to be claimed for GST-free component of service.
485 (labour, laboratory costs) to be claimed for GST-able component of service.
Limit of one (1) per day per denture.
137.90 Limit of one (1) per day per denture. Replacing first tooth on denture
Any repair or tooth replacement in addition to other repairs, alterations or other modifications for same denture on same day
T765
T767 and
T488
No
No
32.85
21.55
Both items must be claimed.
767 to be claimed for GST-free component of service.
488 (labour, laboratory costs) to be claimed for GST-able component of service.
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DENTURE REPAIRS (Cont.)
D ESCRIPTION I TEM
P RIOR
A PPROVAL
No
F EE
$
(E XCL .
GST)
S PECIAL
R EMARKS
139.55 Limit of one (1) per day per denture.
Adding tooth to partial T768 denture to replace an extracted or decoronated tooth
Repair or addition to metal casting
T769 No As per lab Limit of one (1) per day per invoice denture.
Laboratory casting invoice required. Maximum amount payable $276.90
Subject to GST
OTHER PROSTHODONTIC SERVICES
D ESCRIPTION I TEM
P RIOR
A PPROVAL
F EE
$
(E XCL .
GST)
S PECIAL
R EMARKS
Tissue conditioning treatment prior to impressions
Impression where required for denture repair period.
UPR or LWR must be specified.
T776 No 42.05
33.70 Limit of one (1) per denture.
PROFESSIONAL VISITS
D ESCRIPTION I TEM
P RIOR
A PPROVAL
F EE
$
(E XCL .
GST )
61.05
S PECIAL
R EMARKS
Travel to provide services
T916 No
Note: Kilometre Allowance
A kilometre allowance may be paid in addition to a fee for Item 916 ( travel to provide services) if you are required to travel from your normal place of business to visit an entitled person at home or in an institution. The allowance will not be paid for the first 10 kilometres travelled and you must be the nearest suitable provider to the entitled person.
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