The TAC Medical Excess may apply to these services
The TAC will pay the reasonable costs of maxillofacial treatment which is required as a result of transport accident injuries.
Transport Accident Act 1986 reference: s.3 'medical service' and s.60
What does maxillofacial mean?
Maxillofacial refers to the face and jaw which along with the mouth comprise the areas of expertise of an oral and maxillofacial surgeon who deals with the diagnosis, treatment and surgery of disease, injury and defects of the jaw and its associated structures.
When will maxillofacial services be paid?
These are payable by the TAC when they are provided by a registered oral and maxillofacial surgeon and dentist who is approved by the Commonwealth's Minister for Health and Family Services. The TAC's Medical Panel reviews maxillofacial service requests.
Does a provider have to send a description of the treatment plan (for non emergency treatment) to the TAC before its done?
Yes, the TAC often requests a report from a provider on a client's treatment plan for prior authorisation, as this assists in determining whether the treatment is related to the transport accident injuries and if the cost is reasonable. This predetermination is not a guarantee of payment, in fact in some cases the TAC will obtain a second opinion prior to agreeing to contribute to the cost of the treatment plan.
How should providers submit their accounts?
To ensure prompt payment, accounts should be attached to a Dental:Maxillo Facial Report (DTF2) and the account should be fully itemised with a list of the number of services provided for each item, followed by any qualifying information.
Are accounts paid in full?
No, the TAC contributes to the cost of the treatment plan and pays in accordance with the TAC's Schedule of Oral and Maxillo Facial Services Rates and the guidelines set out in Category 4 of the Commonwealth Medical Benefits Schedule (CMBS). Also where a maxillo facial injury is not listed in the CMBS, the TAC will pay according to the TAC's Schedule of Dental Fees. For multiple procedures, provisions of the multiple operation rule will apply. Refer to the policy for General Dental Services.
Does the TAC's rates for treating fractures cover the client's overall management?
Yes, the TAC rates for the treatment of fractures covers the overall management of a client case, including:
- any pre operative consultation other than the initial consultation
- the after care provided for the debridement of wounds
- the removal of teeth and foreign bodies in, or immediately adjacent to, the fracture line
- the suturing of intra oral wounds associated with the fracture.
Only under special circumstances will the TAC pay an additional fee for the above.
What else is payable when treating fractures?
The TAC also pay for:
- the treatment of a fracture of the condyle neck that does not require splinting
- the treatment of a fracture of the alveolus according to the list of services published by the Australia Dental Association (ADA), as this is a dental injury and not a maxillo facial problem
- the reasonable cost of splints and other hardware used in the treatment of fractures, except when those items are provided to an in-patient in a public or private arrangement hospital.
What else does a provider need to know?
A provider should be aware that the TAC:
- will pay for an initial consultation by a specialist practitioner for a singlecourse of treatment
- does not accept that a fracture of the zygoma or of the nasal bones entitles a practitioner to claim for treating a fractured maxilla. In addition, as a Le Fort fracture may involve almost every bone in the middle third of the face, a fee for each bone cannot be claimed
- classifies a comminuted fracture of a facial bone as a single fracture, regardless of the number of fragments present.
Are the assistant's fees payable?
Anassistant's fees are payable when the assistant:
- has been designated an approved dentist by the Commonwealth's Minister for Health and Family Services
- is a postgraduate trainee in oral surgery, in the Department of Oral and Maxillo-Facial Surgery at the University of Melbourne, and has been accepted by the TAC as an assistant for operations.
Are osteotomies payable?
The TAC will not pay for the cost of an initial consultation for these procedures. The costs of preliminary procedures are covered in the TAC's Schedule of Dental Fees. These include an examination, assessment and report, including X-rays, study models, occlusal analysis upon an articulator and photographic records.
The TAC will reimburse the purchase or laboratory cost of substitute bone graft material, plates, screws and bite splints supplied by the surgeon.
Can the TAC fund surgically implanted prostheses?
Refer to the Surgically Implanted Prostheses policy.
Can the TAC fund maxillofacial services by a member of a client's immediate family?
What will the TAC not fund?
The TAC will not fund:
- treatment or services for a person other than the injured client
- treatment or services for a condition that existed before the transport accident or that is not a direct result of the transport accident
- treatment or services where there is no objective evidence that the treatment or service is safe and effective
- treatment or services where there is no clincial justifiation for the treatment or service
- fees associated with non-attendance
- the cost of telephone calls and telephone consultations between providers and clients, and between other providers, including hospitals
- treatment or services provided outside the Commonwealth of Australia
- treatment or services provided more than 2 years prior to the request for funding except where the request for payment is made within 3 years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.
Medical Services Reimbursement Rates
The TAC has adopted the Medicare Benefits Schedule (MBS) items, explanations, definitions, rules and conditions for services provided by medical practitioners. When invoicing for medical services, medical practitioners are expected to adhere to the MBS rules unless otherwise specified by the TAC in the Reimbursement Rates for Medical Services booklet or its medical policies.
The Reimbursement Rates for Medical Services booklet below must be read in conjunction with:
- Medicare Benefits Schedule (MBS)
- Clarification of Medicare Benefits Schedule (MBS) rules
- The TAC invoicing guidelines for medical practitioners PDF, 0.07MB
- The TAC's medical practitioner policy
- Other policies outlined within the Medical Practitioners section of our website
- Reimbursement Rates for Medical Services performed on or after 1 July 2017 (effective 1 December 2017) XLSX, 0.16MB
- Reimbursement Rates for Medical Services performed on or after 1 July 2017 PDF, 1.42MB
- Reimbursement Rates for Medical Services performed between 1 July 2016 and 30 June 2017 XLSX, 0.14MB
- Reimbursement Rates for Medical Services performed between 1 July 2016 and 30 June 2017 PDF, 1.44MB
- Reimbursement Rates for Medical Services performed between 1 July 2015 and 30 June 2016 PDF, 1.42MB
- Reimbursement Rates for Medical Services performed between 1 July 2015 and 30 June 2016 XLSX, 0.21MB
- Reimbursement Rates for Medical Services performed between 1 July 2014 and 30 June 2015 PDF, 1.46MB
- Reimbursement Rates for Medical Services performed between 1 July 2014 and 30 June 2015 (Includes 1 November 2014 MBS updates) XLSX, 0.19MB
At the time of production this publication contained up to date information as released by Medicare Australia (Medicare). The relevant publication will be updated to reflect any further changes that are implemented by Medicare each year. Please check our website for the latest version.
If you have any questions about these publications or the reimbursement rates, please contact the TAC on 1300 654 329. Alternatively, e-mail email@example.com.
Effective 1 July 2017
|Service Description||ADA Number||2017/2018|
|Periodic oral examination||012||$47.92||$47.22||$69.83||$68.81|
|Initial examination and completion of TAC report form "DTF 1"||011, 018||$93.63||$92.26||$115.71||$114.02|
|Consultation arranged by the TAC for a second opinion, including a written report||014, 018||$158.44||$156.13||$221.68||$218.45|
|Single intraoral radiograph||022||$39.05||$38.48||$39.05||$38.48|
|Panoramic radiograph (eg OPG)||037||$103.79||$102.28||$103.79||$102.28|
|Pulp vitality testing - per visit (maximum 3 visits per year)||061||$17.76||$17.50||$17.76||$17.50|
|Photographic records (for the TAC)||072||$26.41||$26.02||$26.41||$26.02|
|(Prior approval from TAC required for these services)|
|Removal of plaque and stain||114||$84.86||$83.62||$84.86||$83.62|
Non-vital bleaching (if separate appointments |
|Topical fluoride treatment||121||$51.01||$50.27||$51.01||$50.27|
Oral hygiene instruction where appropriate |
time is allocated
|Adjunctive General Services|
|Desensitisation of dentine (per visit)||165||$32.74||$32.26||$32.74||$32.26|
|Odontoplasty for fractured teeth (per tooth)||171||$32.74||$32.26||$32.74||$32.26|
|Root planing and subgingival curettage (per segment)||222||FBN*||FBN*||$261.88||$258.06|
|Periodontal flap surgery (per segment)||232||FBN*||FBN*||$698.19||$688.01|
|Osseous surgery (per segment)||233||FBN*||FBN*||$314.90||$310.31|
|Small amount (eg alveolar bone)||234A||$287.43||$283.24|
|Large amount (eg rib graft)||234B||$476.43||$469.48|
|Gingival connective tissue graft||235||FBN*||FBN*||$698.19||$688.01|
|Guided tissue regeneration (per tooth or implant)||236/237||FBN*||FBN*||$698.19||$688.01|
|Expendable GTR material||236A|
|Crown lengthening - including alveolar bone removal (per tooth). NB: Multiple operation rule applies||238||FBN*||FBN*||$537.16||$529.33|
|Extraction of a single tooth||311||$121.75||$119.97||$152.13||$149.91|
|Sectional removal of tooth||314||$179.08||$176.47||$188.49||$185.74|
|Surgical extraction without bone removal||322||$179.08||$176.47||$188.49||$185.74|
|Surgical extraction requiring bone removal||323||$229.64||$226.29||$281.06||$276.96|
|Removal of soft tissue||377||$46.22||$45.55||$46.22||$45.55|
|Repositioning and splinting of displaced tooth||386||$190.01||$187.24||$237.88||$234.41|
|Replanting avulsed tooth and splinting||387, 772||$269.91||$265.97||$382.00||$376.43|
|Extirpation of pulp or debridement of root canal - 1 canal||415†||$216.13||$212.98||$316.29||$311.68|
|Extirpation of pulp or debridement of root canal - each additional canal||416||$96.37||$94.96||$129.98||$128.08|
|Root canal obturation - 1 canal||417†||$224.79||$221.51||$323.60||$318.88|
|Root canal obturation - each additional canal||418||$96.37||$94.96||$129.98||$128.08|
|Emergency endodontic procedure not exceeding 15 minutes||419||$121.75||$119.97||$152.13||$149.91|
|Apicectomy and apical seal||432, 434||$235.06||$231.63||$312.50||$307.94|
|Apexification - fee additional to routine endodontic treatment||458||$134.01||$132.06||$210.62||$207.55|
|Removal of root filling (per canal)||451||$88.96||$87.66||$126.82||$124.97|
|Additional visit for irrigation and/or dressing of the root canal system||455||$85.73||$84.48||$103.79||$102.28|
|† These fees include the cost of x-rays where required|
|Metallic restoration - 1 surface||511||$101.79||$100.31||$128.39||$126.52|
|Metallic restoration - 2 surfaces||512||$121.74||$119.96||$166.33||$163.90|
|Metallic restoration - 3 surfaces||513||$144.35||$142.24||$210.62||$207.55|
|Adhesive resin restoration: anterior tooth - 1 surface||521||$111.63||$110.00||$141.20||$139.14|
|Adhesive resin restoration: anterior tooth - 2 surfaces||522||$131.85||$129.93||$178.37||$175.77|
|Adhesive resin restoration: anterior tooth - 3 surfaces||523||$152.13||$149.91||$216.13||$212.98|
|Adhesive resin restoration: anterior tooth - 4 surfaces||524||$183.85||$181.17||$252.83||$249.14|
|Adhesive resin restoration: posterior tooth - 1 surface||531||$117.70||$115.98||$147.03||$144.89|
|Adhesive resin restoration: posterior tooth - 2 surfaces||532||$141.95||$139.88||$177.50||$174.91|
|Adhesive resin restoration: posterior tooth - 3 surfaces||533||$170.37||$167.89||$223.97||$220.70|
|Metallic inlay or onlay - 2 surface cavity||542||$612.85||$603.91||$739.45||$728.67|
|Metallic inlay or onlay - 3 surface cavity||543||$720.39||$709.88||$889.67||$876.69|
|In the administration of the TAC's dental service the term "gold" shall be restricted to alloys with a gold content of not less than 40% and with total precious metal content in excess of 60%. Any other dental alloy will be classified as "non precious metal".|
|Complex coronal metallic reconstruction in amalgam||515||$189.30||$186.54||$265.34||$261.47|
|Complex coronal reconstruction in tooth coloured adhesive resin - direct||525/535||$281.06||$276.96||$360.08||$354.83|
|Temporary restoration emergency or interim treatment only||572||$95.15||$93.76||$118.87||$117.14|
|Pin retention (per unit pin)||575||$27.99||$27.58||$27.99||$27.58|
|Enamel bonded adhesive resin facing||582||$253.53||$249.83||$316.83||$312.21|
|Indirect bonded facing||583||$840.45||$828.19||$1,065.86||$1,050.32|
|Post - direct preformed||597||$95.15||$93.76||$118.87||$117.14|
|Temporary composite bridge when not part of definitive treatment (per pontic)||632||$198.01||$195.12||$243.00||$239.46|
|Crown and Bridgework|
|Bridges should be described in terms of the Australian Dental Association's Schedule of Dental Services. However, in addition to the number of units, the number of abutment teeth and pontics should be stated [eg 3 units (2+1). The fee which the TAC will consider reasonable may be calculated by adding the fees listed for the restoration of the abutment teeth to the fees listed for the pontic or pontics as hereunder specified.|
|Indirect non-metallic full crown||613||$1,226.00||$1,208.12||$1,602.57||$1,579.20|
|Indirect veneered full crown||615||$1,314.72||$1,295.55||$1,686.44||$1,661.84|
|Full crown - metallic||618||$1,226.00||$1,208.12||$1,602.57||$1,579.20|
|Cast core for crown including post||625||$307.07||$302.59||$537.16||$529.33|
|Preliminary restoration for crown||627||$189.30||$186.54||$265.33||$261.46|
|Pontics - direct||642||$230.44||$227.08||$307.05||$302.57|
|Pontics - indirect||643||$1,016.53||$1,001.70||$1,270.54||$1,252.01|
|Bridge - indirect bonded (Maryland)|
|1 pontic||643/ 649||$1,314.72||$1,295.55||$1,583.58||$1,560.48|
|2 pontics||643/ 649||$1,891.87||$1,864.28||$2,358.85||$2,324.45|
|Implant based veneered - full crown||661, 672||$2,000.18||$1,971.01||$2,440.38||$2,404.79|
|Surgical Procedures For Implant Prostheses|
|Hardware for implant procedures||661A|
|Prosthesis with metal frame for bridgework (per implant)||666||$1,559.77||$1,537.02|
|Removal and reattachment of implant prosthesis for repair or cleaning||669||$158.44||$156.13|
|Surgical implant guide||679||$216.13||$212.98||$216.13||$212.98|
|Osseo-integration procedure - intraoral implantation of titanium fixture||684||FBN*||FBN*||$960.55||$946.54|
|Osseo-integration procedure - one-stage||688||FBN*||FBN*||$1,074.23||$1,058.56|
|Osseo-integration procedure - fixation of transcutaneous abutment||691||FBN*||FBN*||$363.46||$358.16|
If these procedures are to be carried out in a hospital under general anaesthesia, prior approval must be obtained from TAC.|
For the second and subsequent fixtures inserted at the same appointment, the multiple operation rule applies.
In addition, the surgeon is entitled to reimbursement for the retail cost of any expendable implant hardware supplied directly.
|Prosthodontics - Full Dentures|
|Full upper or full lower dentures||711, 712||$861.95||$849.38||$1,283.98||$1,265.25|
|Full upper and full lower dentures||719||$1,520.64||$1,498.46||$2,391.48||$2,356.60|
|Prosthodontics - Partial Dentures|
|Partial denture - acrylic base:|
|Five to nine teeth||721E/722E||$646.35||$636.92||$807.89||$796.11|
|Ten teeth or more||721F/722F||$823.72||$811.71||$1,029.69||$1,014.67|
|Partial denture - chrome cobalt including cost of casting:|
|One or two teeth||727A/728A||$1,317.89||$1,298.67||$1,647.35||$1,623.32|
|Three or four teeth||727B/728B||$1,406.61||$1,386.10||$1,758.20||$1,732.56|
|Five to nine teeth||727C/728C||$1,520.64||$1,498.46||$1,900.75||$1,873.03|
|Ten teeth or more||727D/728D||$1,609.34||$1,585.87||$2,011.64||$1,982.30|
|Additional items for Acrylic Dentures only|
|Occlusal rest (not part of retainer)||732||$15.30||$15.08||$15.30||$15.08|
|Immediate tooth replacement||736||$10.29||$10.14||$10.29||$10.14|
|Full denture relining||743||$301.10||$296.71||$376.45||$370.96|
|Partial denture relining||744||$264.63||$260.77||$329.57||$324.76|
|Denture base modification||754||$153.58||$151.34||$153.58||$151.34|
|Adding tooth to partial denture to replace extracted tooth||768||$148.92||$146.75||$148.92||$146.75|
|Active removable appliance therapy - one arch||821||$711.75||$701.37||$1,028.35||$1,013.35|
|Full arch banding - one arch||831||N/A||N/A||$3,722.40||$3,668.11|
|Full course of fixed appliance orthodontic treatment||881||N/A||N/A||$5,805.32||$5,720.65|
|Orthodontic extrusion of tooth||846||N/A||N/A||$844.54||$832.22|
|Temporomandibular Joint Therapy|
|Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report to the TAC.||963, 964||$227.11||$223.80||$278.60||$274.54|
|Occlusal splint including initial programming||965||$515.42||$507.90||$607.60||$598.74|
|Routine adjustment of splint - per visit (maximum of 6 visits)||966||$85.68||$84.43||$108.01||$106.43|
|Travel - Treatment outside of rooms||FBN*||FBN*|
* Note: Where the terminology FBN appears in this schedule, the fee must be negotiated with the TAC before any dental treatment is commenced.
View Dental: maxillo facial report form
Dental: maxillo facial report form
This form is for dental or maxillofacial treatment providers to report damage caused to a client's jaw or face as a result of their accident and the treatment given.