FIGURE 12: PRIVATE SECTOR SERVICE BILLING PATTERNS BY JURISDICTION (1 JANUARY 2014–30 JUNE 2015) Source: Health analysis of claiming data The noted the high bulk billing rate under the CDBS. STEP-DOWN FEES The CDBS provides for the payment of reduced (step-down) benefits for certain services where more than one service is provided on the same day. The CDBS structure is modelled on the step-down fee structure used for the Chronic Disease Dental Scheme, where a different item number is used to pay a lower benefit for subsequent similar services on the same day. Table 7 shows the CDBS item and step-down items for extraction services. The CDBS also has a step-down fee for fissure sealants, with the first four services attracting a benefit of $46.05, and subsequent services a benefit of $23.05 (50 per cent reduction). TABLE 7: CDBS STEP-DOWN FEES STRUCTURE FOR EXTRACTION ITEMS Fee for tooth Item extracted on Subsequent Item and Reduction number Service Description a day fee percentage 88311 Removal of a or part(s) thereof $131.30 Additional extraction 37.0% item 88316—$82.75 88314 Sectional removal of a $167.80 50.7% or part(s) thereof 88322 Surgical removal of a tooth or tooth $213.10 Additional extraction 18.2% fragment not requiring removal of bone item 88326—$174.35 or tooth division 88323 Surgical removal of a or tooth $243.35 28.4% fragment requiring removal of bone 88324 Surgical removal of a tooth or tooth $327.35 46.7% fragment requiring both removal of bone and tooth division Source: Dental Benefits Rules 2014 Veterans’ Affairs provides benefits for a range of dental services for certain veterans, war widows and eligible dependents. The Fee Schedule of Dental Services for Dentists and Dental Specialists outlines all the dental items covered under the Veterans’ Affairs dental scheme. As with the CDBS, Veterans’ Affairs has a step-down fee for the five extraction items (Table 8). Unlike the CDBS, however, Veterans’ Affairs will pay the higher fee for the first extracted tooth from each quadrant of the mouth, and pay a step-down fee for the second and subsequent extractions from the same quadrant on the same day.
FIGURE 12: PRIVATE SECTOR SERVICE BILLING PATTERNS BY JURISDICTION (1 JANUARY 2014–30 JUNE 2015) Source: Health analysis of claiming data The noted the high bulk billing rate under the CDBS. STEP-DOWN FEES The CDBS provides for the payment of reduced (step-down) benefits for certain services where more than one service is provided on the same day. The CDBS structure is modelled on the step-down fee structure used for the Chronic Disease Dental Scheme, where a different item number is used to pay a lower benefit for subsequent similar services on the same day. Table 7 shows the CDBS item and step-down items for extraction services. The CDBS also has a step-down fee for fissure sealants, with the first four services attracting a benefit of $46.05, and subsequent services a benefit of $23.05 (50 per cent reduction). TABLE 7: CDBS STEP-DOWN FEES STRUCTURE FOR EXTRACTION ITEMS Item number Service Description Fee for tooth extracted on a day Subsequent Item and fee Reduction percentage 88311 Removal of a or part(s) thereof $131.30 Additional extraction item 88316—$82.75 37.0% 88314 Sectional removal of a or part(s) thereof $167.80 50.7% 88322 Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division $213.10 Additional extraction item 88326—$174.35 18.2% 88323 Surgical removal of a or tooth fragment requiring removal of bone $243.35 28.4% 88324 Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division $327.35 46.7% Source: Dental Benefits Rules 2014 Veterans’ Affairs provides benefits for a range of dental services for certain veterans, war widows and eligible dependents. The Fee Schedule of Dental Services for Dentists and Dental Specialists outlines all the dental items covered under the Veterans’ Affairs dental scheme. As with the CDBS, Veterans’ Affairs has a step-down fee for the five extraction items (Table 8). Unlike the CDBS, however, Veterans’ Affairs will pay the higher fee for the first extracted tooth from each quadrant of the mouth, and pay a step-down fee for the second and subsequent extractions from the same quadrant on the same day.
Report%20on%20the%20Third%20Review%20of%20the%20Dental%20Benefits%20Act%202008%20-%20A4%20(D16-150739).DOCX