Medicare CBCT Changes

3D CBCT imaging technology has been a popular choice for a wide range of dental practices looking for enhanced diagnostic information to improve treatment options.

While many 3D CBCT equipment users charge their patients direct (utilising private health insurance where available), some choose to use a teleradiology service to enable access to Medicare or send patients to imaging centres with CBCT equipment.

From 1 November 2014, Medicare has changed the item numbers and placed restrictions on how they can be applied.

Many existing users have taken unfair advantage of the Medicare system and the Medical Services Advisory Committee were brought in to review the use of CBCT imaging. Over-servicing and concerns of unnecessary radiation exposure were raised as some issues.

As a result, there have been significant changes, with Medicare item numbers amended and added restrictions to encourage the judicious use of CBCT. The main changes are:

  • Co-claiming for more than one CBCT per day (or CBCT plus a panoramic image) not permissible.
  • CBCT scans can be requested ONLY by Medicare-eligible medical practitioners and specialist dentists: General dentists can no longer request CBCT services under Medicare.
  • Services performed on hybrid units are excluded
  • CBCT services can only be performed at practices that are DIAS-accredited (Diagnostic Imaging Accreditation Scheme)

It is important to note these changes will only impact on those accessing Medicare (using teleradiology services or referring to imaging centres).

What does this mean?
For the general practice with existing CBCT equipment:

If you access Medicare via a teleradiology service, you will no longer be able to. You will either have to have a specialist referrer, or charge your patient out-of-pocket or through private health insurance.

For the general practice who refers patients to imaging centres:
You will no longer be able to refer.

For dental specialists:
If you are using a teleradiology service to access Medicare, or referring to an imaging centre, check with your provider to see if the changes will affect your practice or their ability to provide.

For either general dental or specialist practices who rely on CBCT imaging:
These restrictions are only applicable to those accessing Medicare. If you see CBCT imaging as vital to your practice, charging out-of-pocket or through private health insurers is still available as normal, but due to the restrictions, may need to be accessed in-house instead of through referrals.

For more information, visit http://www.health.gov.au/internet/main/Publishing.nsf/Content/diagnosticimaging-aboutus.htm

Disclaimer: Whilst the information contained on this factsheet has been formulated with care, Australian Imaging does not accept any liability to any person for the information, or use of such information, which it contains. The information is provided for information purposes only and does not constitute legal advice.