Maxillofacial Services

The TAC Medical Excess may apply to these services 

 

 

Policy

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

Guidelines

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?

Refer to the Funding Treatment by a Member of a Client's Immediate Family policy.

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:

Current Rates

Previous Rates

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 info@tac.vic.gov.au.

Dental Services

Effective 1 July 2017

GP SP
Service Description ADA Number 2017/2018
Maximum
Payment
Rate
2016/2017
Maximum
Payment
Rate
2017/2018
Maximum
Payment
Rate
2016/17
Maximum
Payment
Rate
Diagnostic services
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
Cephalometric radiograph 036 $103.79$102.28 $103.79$102.28
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
Diagnostic model 071 $47.75$47.05 $47.75$47.05
Photographic records (for the TAC) 072 $26.41$26.02 $26.41$26.02
Preventive Services
(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
are made)
117 $164.63$162.23$205.83 $202.83
Topical fluoride treatment 121 $51.01$50.27 $51.01$50.27
Oral hygiene instruction where appropriate
time is allocated
141 $30.49$30.05 $38.10$37.54
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
Periodontics     
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
Osseous graft      
    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
Oral Surgery
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
Endodontics
Pulp capping 411 $32.49$32.02 $40.62$40.03
Cvek pulpotomy 414 $118.64$116.91 $173.47$170.94
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
Restorative Services     
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:      
     One tooth 721A/722A $380.24$374.69 $475.27$468.34
     Two teeth 721B/722B $424.60$418.41 $530.68$522.94
     Three teeth 721C/722C $468.91$462.07 $587.67$579.10
     Four teeth 721D/722D $557.62$549.49$697.01 $686.84
     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
Each retainer 731 $44.42$43.77 $44.42$43.77
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
Orthodontics
Active removable appliance therapy - one arch 821 $711.75$701.37 $1,028.35$1,013.35
Full arch banding - one arch 831 N/AN/A $3,722.40$3,668.11
Full course of fixed appliance orthodontic treatment 881 N/AN/A $5,805.32$5,720.65
Orthodontic extrusion of tooth 846 N/AN/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

Summary:

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.