Dental service providers

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Who can receive dental services?

Department of Veterans' Affairs (DVA) will fund all dental services, provided under DVA arrangements, necessary to meet a clinical need for Veteran Gold Card holders. For Veteran White Card holders, dental treatment can only be provided in relation to your accepted disabilities.

Note

If unsure, providers can confirm treatment eligibility of a Veteran White Card holder's accepted condition(s), by calling DVA on 1800 VETERAN (1800 838 372) — select Option 3, then Option 1.

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Dental services by dental therapists, dental hygienists and oral health therapists

Dental therapists, dental hygienists and oral health therapists can provide dental services to members of the veteran community if they are:

• registered with the Dental Board of Australia and comply with approved scope of practice registration standards
• covered by either their employer's indemnity insurance or maintain their own insurance as mandated by the Dental Board of Australia
• qualified and competent to provide the service.

Claims for these services are to be submitted by the dentist or dental specialist on their behalf at the current DVA dental fee.

See also: How to become a DVA health provider

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Notes for dental providers

These notes explain the procedures to be followed when providing health care services to eligible members of the veteran community.

• Notes for allied health providers, section 1 — general

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Prescribing pharmaceuticals under the Repatriation Pharmaceutical Benefits Scheme (RPBS)

The list of pharmaceuticals approved for prescribing by dentists under the RPBS can be found under 'Dental Items' at the PBS website.

Enquiries regarding RPBS dental prescribing can be directed to the Veterans' Affairs Pharmaceutical Advisory Centre (VAPAC) on 1800 552 580 (24-hour free call).

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Fee schedules

Summary of fee schedules A, B and C for dentists and dental specialists

Schedules A, B and C together form the DVA comprehensive dental schedule. For further information see the fee schedule on dental and allied health fee schedules.

Note

A separate fee schedule exists for dental prosthetists.

Schedule A

• Prior approval not required for Veteran Gold Card or Veteran White Card holders (except where specified)
• Prior approval is required for items marked with an asterisk (*) if treatment is provided above the quantity and/or time limits listed in Schedule A
• No annual monetary limit.

Schedule B

• Prior approval required for all Veteran card holders
• No annual monetary limit.

Schedule C

• Prior approval generally not required (see exceptions below)
• Annual monetary limit (AML)
  • applies for all services provided from Schedule C (refer to dentists and dental specialists fee schedule for the current limit)
  • see exceptions below

Exceptions

• Prior approval is required for treatment plans that include Schedule C items for all eligible persons who are exempt from the AML.
• The AML does not apply to all ex-prisoners of war (POWs) and eligible persons receiving dental treatment related to war-caused disabilities or malignant neoplasia.
• Refer to the dental and allied health fee schedules for detailed information.

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Annual monetary limit to dental services

• An AML applies to all items listed as Schedule C in the fee schedule for dentists and dental specialists.
• Refer to the dentists and dental specialists fee schedule for the current limit.
• The limit is not cumulative, so any part of the limit not expended in a calendar year cannot be used in subsequent years.
• Before providing services, you should discuss this matter with your patient and check with DVA whether any or all of their limit has been expended for that calendar year.

Exemptions

• Veterans exempt from this limit are:

  • ex-prisoners of war
  • Veteran Card holders receiving treatment for an accepted condition.
  • Veteran Card holders with a condition associated with malignant neoplasia

DVA will pay for the full cost of Schedule C treatment for exempt beneficiaries, subject to the following conditions:

• you must obtain prior approval from DVA before commencing treatment
• the maximum fee payable is the approved Commonwealth fee for the particular service, and where the fee is 'Fee by negotiation', the fee paid is that which is negotiated with DVA
• you must not make any separate charge against the Veteran Card holder.

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What dental services require prior financial approval?

Providers must contact DVA before administering the following services to be able to claim for payment:

• all services listed as Schedule B items in the Fee Schedule of Dental Services for Dentists and Dental Specialists
• all services listed as requiring prior approval in the Fee Schedule of Dental Services for Dental Prosthetists
• any service that is not listed in the fee schedules
• treatment plans which include Schedule C items for all DVA entitled persons who are exempt from the annual monetary limit
• all 'fee by negotiation' items
• the treatment of a DVA entitled person requiring the use of a general anaesthetic

You must not commence treatment until DVA advises you of the result of your request.

Refer to the full fee schedule for items requiring prior approval.

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Dental implants treatment — policy and prior approvals processes

All dental implant treatment requires prior approval from DVA.

The Osseo-integrated Dental Implant Policy and Guidelines sets out the circumstances in which DVA may accept financial responsibility for dental implant treatment.

• Osseo-integrated Dental Implant Policy and Guidelines (PDF 160 KB)
  Osseo-integrated Dental Implant Policy and Guidelines (DOCX 25 KB)

To request approval for dental implant treatment for a DVA client see the request form.

Note

• Crowns that attach to implants (items D/S671, D/S672 and D/S673) require prior approval
• Where implants are provided in a public hospital, in some states, the cost of the prostheses are included in the bed rate and therefore the specialist may need to liaise with the hospital as to payment or arrangements for the equipment to be provided for the surgery

Important information on the completion of the implant request forms

In January 2018, DVA updated the Dental Implants request form. The updated form requires the input of the restorative phase provider and the surgical phase provider of the dental implant treatment. The medical General Practitioner no longer needs to complete a form for dental implant treatment requests.

Additionally the separate forms for the restorative phase and surgical phase providers have been combined into a single form, with a section for each provider to complete. Finally, the same form is now used for both single tooth implants and implant retained dentures. The new form follows:

• D9323 — Request for prior approval for dental implants

If you require access to the previous forms as you are part way through a dental implant request, and one provider has already completed the old individual forms, please call the Health Approvals team on 1800 550 457.

The restorative phase provider is considered to be the case coordinator for the provision of the single request form. They are responsible for ensuring the single request form is fully and correctly completed by both providers.

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Request prior financial approval and claim for payment

Prior financial approval

To request prior approval from DVA, send a completed D0986 — Dental Request Form to health.approval [at] dva.gov.au (health[dot]approval[at]dva[dot]gov[dot]au), or if you do not have access to email please mail to:

Health Approvals & Home Care team
Department of Veterans' Affairs
GPO Box 9998
Brisbane QLD 4001

For urgent cases or for further information on dental services, please contact the Health Approvals & Home Care team on 1800 550 457, or via health.approval [at] dva.gov.au (health[dot]approval[at]dva[dot]gov[dot]au).

Note

The above prior approval request process applies for veterans who may be entitled under New Zealand or another Allied Country's legislation.

Claim for payment

Claims should be submitted as soon as possible after treatment has been provided.

For claiming enquiries please contact Veterans' Affairs Processing on 1300 550 017

For manual claiming please send all claims for payment to:

Veterans' Affairs Processing
Services Australia
GPO Box 964
ADELAIDE SA 5001

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DVA Dental Review

We are reviewing the dental program to make sure it continues to meet current and evolving needs of the veteran community. The consultation period closes 18 December 2020. To read a copy of the discussion paper and download the submission template, visit DVA Dental Review

Forms

• D1217 — Claim for Treatment Services Voucher (PDF 98 KB)

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