What changed (since 1 July 2022)
From 1 July 2022, dental hygienists, dental therapists and oral health therapists can obtain their own Child Dental Benefits Schedule (CDBS) provider numbers, allowing them to directly claim certain CDBS services.
Before this, these practitioners were generally required to work under a dentist’s provider number (i.e., a dentist claimed for services delivered by hygienists/therapists).
The change reflects a regulatory update: the Dental Board of Australia (DBA) introduced a new Scope-of-Practice Registration Standard in 2020 that allows hygienists, therapists and oral health therapists to practice independently (within their scope of competence).
Do hygienists/therapists have to get a provider number?
No, obtaining a Medicare provider number is optional (“opt-in”).
If they choose not to get one, a dentist can continue to claim for the services they deliver under the dentist’s provider number.
The decision is typically made in consultation with the dental practice/employer.
How to apply for a provider number
From 20 June 2022, practitioners can apply via the form HW093 – Application for a Medicare provider number and/or prescriber number for allied health and non-medical health professionals.
More information can be found on the Services Australia website.Submit the completed form to Services Australia.
Processing is manual. It usually takes at least two weeks. After approval, Services Australia issues a letter with the new provider number.
If the practitioner works at more than one location, they can apply for additional provider numbers via the Services Australia online portal after obtaining the initial number.
What services can be claimed using a provider number
The services available for direct claiming depend on the practitioner’s registration type (hygienist, therapist, oral health therapist).
Eligible services are those listed under the CDBS schedule. The detailed list (item numbers, descriptors, benefit amounts, restrictions) is available in the official CDBS Guide.
Important limitation: Having a provider number and claiming under CDBS does not grant rights to claim under the Medicare Benefits Schedule (MBS) or to independently refer for MBS-listed services (e.g., diagnostic imaging, specialist referrals). Such MBS services must still be requested/referral-made under a dentist’s auspices.
Other considerations & practicalities
Provider numbers and item codes are essentially commercial tools: even if a practitioner has a provider number, whether a private health fund recognises that number for extras/dental-benefit claims is up to the fund. There is no uniformity across funds.
Once issued, provider numbers typically flow through to billing software (e.g., HICAPS), though there might be a lag before they appear.
For locum/hired therapists working temporarily at a practice: there may be allowance for using a principal provider’s number for a short period (e.g. 2 weeks), but clinical notes must clearly identify the treating practitioner.
In Summary
Dental hygienists, dental therapists and oral health therapists can apply for their own Medicare provider number to directly claim eligible CDBS services.
Getting a provider number is optional, dentists can still claim on their behalf if preferred.
A provider number does not allow access to MBS items or the ability to make MBS referrals.
Private health fund acceptance of these provider numbers varies, so practices may need to check with each fund.
Application is via the HW093 form, and approval generally takes at least two weeks.