Class Ruling

CR 2013/14

Goods and services tax: goods and services supplied by dentists

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Contents Para
LEGALLY BINDING SECTION:
 
What this Ruling is about
Relevant provisions
Date of effect
Scheme
Ruling
Attachment A:
 
NOT LEGALLY BINDING SECTION:
 
Appendix 1:
 
Explanation
Appendix 2:
 
Detailed contents list

Exclamation This publication provides you with the following level of protection:

This publication (excluding appendixes) is a public ruling for the purposes of the Taxation Administration Act 1953.

A public ruling is an expression of the Commissioner's opinion about the way in which a relevant provision applies, or would apply, to entities generally or to a class of entities in relation to a particular scheme or a class of schemes.

If you rely on this ruling, the Commissioner must apply the law to you in the way set out in the ruling (unless the Commissioner is satisfied that the ruling is incorrect and disadvantages you, in which case the law may be applied to you in a way that is more favourable for you - provided the Commissioner is not prevented from doing so by a time limit imposed by the law). You will be protected from having to pay any underpaid tax, penalty or interest in respect of the matters covered by this ruling if it turns out that it does not correctly state how the relevant provision applies to you.

[ Note: This is a consolidated version of this document. Refer to the Legal Database (https://www.ato.gov.au/law) to check its currency and to view the details of all changes.]

What this Ruling is about

1. This Ruling sets out the Commissioner's opinion on the way in which the relevant provision(s) identified below apply to the defined class of entities, who take part in the scheme to which this Ruling relates.

Relevant provision(s)

2. The relevant provisions dealt with in this Ruling are:

·
section 9-5 of the A New Tax System (Goods and Services Tax) Act 1999 (GST Act)
·
section 9-80 of the GST Act
·
section 38-7 of the GST Act
·
section 38-10 of the GST Act
·
section 38-60 of the GST Act
·
section 38-45 of the GST Act
·
section 195-1 of the GST Act

All subsequent legislative references in the Ruling are to the GST Act unless otherwise indicated.

Class of entities

3. The class of entities to which this Ruling applies consists of dentists who are members of the Australian Dental Association Inc (ADA).

4. Reference to a dentist is a reference to a dentist who is a recognised professional.

Qualifications

5. The Commissioner makes this Ruling based on the precise scheme identified in this Ruling.

6. The class of entities defined in this Ruling may rely on its contents provided the scheme actually carried out is carried out in accordance with the scheme described in paragraphs 10 to 14 of this Ruling.

7. If the scheme actually carried out is materially different from the scheme that is described in this Ruling, then this Ruling:

·
has no binding effect on the Commissioner because the scheme entered into is not the scheme on which the Commissioner has ruled; and
·
may be withdrawn or modified.

8. [Omitted.]

Date of effect

9. This Ruling applies on or after 20 February 2013. However, this Ruling will not apply to taxpayers to the extent that it conflicts with the terms of a settlement of a dispute agreed to before the date of issue of this Ruling (see paragraphs 75 and 76 of Taxation Ruling TR 2006/10).

Scheme

10. The following description of the scheme is based on information provided by the applicant.

11. Members of the ADA consist of dentists and dental students.

12. The dentists supply their services to patients and third parties.

13. The dentists also supply customised toothbrushes for people with disabilities, dentures and artificial teeth, and mandibular advancement splints. These products are listed as medical aids and appliances in Schedule 3 to the GST Act.

14. The supplies made by dentists also include specifically designed spare parts for medical aids and appliances and repairs and modifications to the medical aids and appliances.

Ruling

15. This Ruling addresses the goods and services tax (GST) treatment of the supply of goods and services by dentists. This Ruling includes Attachment A at page 23.

Supplies made by dentists under section 38-7

Supplies of services

16. Supplies of dental services and repairs of dental goods by a dentist to a patient for which a medicare benefit is payable under Part II of the Health Insurance Act 1973 are GST-free under subsection 38-7(1) (see paragraphs 31 to 34 of this Class Ruling).

Supplies of goods to patients (goods other than medical aids and appliances covered by section 38-45)

17. Supplies of goods to a patient in the course of supplying that patient with a GST-free service under subsection 38-7(1) are also GST-free under subsection 38-7(3) if the supply is made to the patient at the premises at which the GST-free service is supplied (see paragraphs 68 to 69 of this Class Ruling).

Supplies made by dentists under section 38-10

Supplies of services

18. Supplies of dental services by a dentist to a patient that are generally accepted in the dental profession as being necessary for the appropriate treatment of that patient are GST-free under subsection 38-10(1) (see paragraphs 35 to 67 of this Class Ruling).

Supplies of goods to patients (goods other than medical aids and appliances covered by section 38-45)

19. Supplies of goods to a patient in the course of supplying that patient with a GST-free dental service under subsection 38-10(1) are also GST-free under subsection 38-10(3) if the supply is made to that patient at the premises at which the GST-free service is supplied (see paragraphs 68 to 69 of this Class Ruling).

Supplies of medical aids and appliances under section 38-45

Supplies of medical aids and appliances used in the dental industry

20. Supplies of 'customised toothbrushes for people with disabilities', 'dentures and artificial teeth', and 'mandibular advancement splints' are GST-free under subsection 38-45(1) at all points in the supply chain. Things made or consumed in the process of constructing and supplying one of these items form part of the one overall GST-free supply of that item, even if the components are itemised separately on the bill (see paragraphs 70 to 81 of this Class Ruling).

Supplies of specifically designed spare parts for medical aids and appliances

21. The supply of a specifically designed spare part for a GST-free medical aid or appliance ('customised toothbrushes for people with disabilities', 'dentures and artificial teeth', and 'mandibular advancement splints') is GST-free under subsection 38-45(2).

22. Generic spare parts that are not specifically designed for a GST-free medical aid or appliance are not GST-free (see paragraphs 82 to 85 of this Class Ruling).

Supplies of specifically designed spare parts with labour services

23. Where a specifically designed spare part is supplied together with a labour component that is not GST-free by itself, the GST treatment will depend on how the supply is characterised (see paragraphs 87 to 97 of this Class Ruling).

24. A supply is GST-free if the dominant part of the supply is the specifically designed spare part and the labour is merely integral, ancillary or incidental to the supply of the spare part. However, the supply is taxable[1] if the dominant part is the labour and the spare part is merely integral, ancillary or incidental to the labour.

25. If neither the specifically designed spare part nor the labour is integral, ancillary or incidental to the other, the supply is a mixed supply that is partly GST-free (the spare part) and partly taxable (the labour).

Commissioner of Taxation
20 February 2013

Appendix 1 - Explanation

Exclamation This Appendix is provided as information to help you understand how the Commissioner's view has been reached. It does not form part of the binding public ruling.

26. Under the GST Act, some goods and services supplied by dentists are GST-free where certain requirements are satisfied.

27. GST is payable on supplies that are taxable supplies but not on those that are GST-free. A dentist may claim input tax credits for the GST included in the price of things acquired for making taxable or GST-free supplies or both.

Taxable supplies - section 9-5

28. Under section 9-5, an entity makes a taxable supply if:

·
it is made for consideration
·
it is made in the course or furtherance of an enterprise that the entity carries on
·
the supply is connected with Australia, and
·
the entity is registered or required to be registered for GST.

29. However, section 9-5 also provides that a supply is not taxable to the extent that it is GST-free or input taxed.

30. For the purposes of this ruling, the provisions of the GST Act dealing with input taxed supplies are not relevant to any supplies made in the dental industry. The relevant GST-free provisions of the GST Act are considered below.

GST- free supplies under section 38-7

Medical services - subsection 38-7(1)

31. Subsection 38-7(1) states:


A supply of a *medical service is GST-free.

32. 'Medical service' is defined in section 195-1 to mean:

(a)
a service for which a medicare benefit is payable under Part II of the Health Insurance Act 1973; or
(b)
...(this part of the definition is not relevant to dental services)

33. Some dental services (including repairs of dental goods) are listed in the Medicare Benefits Schedule. For a dental service to be GST-free under subsection 38-7(1), a medicare benefit must be payable for that service.[2]

34. Where a dental service is listed in the Medicare Benefits Schedule but a medicare benefit is not payable because certain other criteria are not met, the definition of medical service is not satisfied. For example, a medicare benefit is not payable for a supply of a dental service to a non-resident even though that service is listed in the Medicare Benefits Schedule. In these circumstances, whether the dental service is GST-free or not needs to be considered under section 38-10.

GST-free supplies under section 38-10

Dental services - subsection 38-10(1)

35. Subsection 38-10(1) states:


A supply is GST-free if:

(a)
it is a service of a kind specified in the table in this subsection, or of a kind specified in the regulations; and
(b)
the supplier is a *recognised professional in relation to the supply of services of that kind; and
(c)
the supply would generally be accepted, in the profession associated with supplying services of that kind, as being necessary for the appropriate treatment of the *recipient of the supply.

36. All three of the requirements must be satisfied for a supply of dental services to be GST-free under this category.

Paragraph 38-10(1)(a)

Are dental services specified in the table or the regulations?

37. 'Dental' is a service specified at item 6 in the table in subsection 38-10(1).

Paragraph 38-10(1)(b)

Who is a recognised professional in relation to the supply of dental services?

38. Section 195-1 defines 'recognised professional' to mean the following:


A person is a recognised professional, in relation to the supply of a service of kind specified in the table in subsection 38-10(1), if:

(a)
the service is supplied in a State or Territory in which the person has a permission or approval, or is registered, under a *State law or a *Territory law prohibiting the supply of services of that kind without such permission, approval or registration; or
(b)
the service is supplied in a State or territory in which there is no State law or Territory law requiring such permission, approval or registration, and the person is a member of a professional association that has uniform national registration requirements relating to the supply of services of that kind; or
(c)
in the case of services covered by item 3 in the table - the service is supplied by an accredited service provider within the meaning of section 4 of the Hearing Services Administration Act 1977.

39. In all States and Territories, dentists are required to be registered pursuant to the relevant State or Territory Act. Accordingly, a person who is registered pursuant to the State or Territory Act will be considered to be a 'recognised professional' in dental services pursuant to paragraph 195-1(a).

Paragraph 38-10(1)(c)

40. To satisfy this requirement, the service must generally be accepted in the profession associated with supplying services of that kind (in this case, the dental profession) as being necessary for the appropriate treatment of the recipient of the supply.

What is 'appropriate treatment'?

41. A dentist will provide 'appropriate treatment' to the patient if the dentist assesses the patient's state of health and determines a process for preserving, restoring or improving the physical or psychological wellbeing of that patient. 'Appropriate treatment' includes any subsequent services provided to the patient as part of that process.

42. 'Appropriate treatment' also includes medical treatment of a preventative nature, for example, a periodic oral examination where there is no evidence of an ailment prior to attendance. However, this does not extend to the supply of services and goods in relation to customised mouthguards. Whilst a customised mouthguard is a device that may prevent or reduce damage sustained to the mouth and teeth in the event of an injury, it is not considered to be 'treatment' that is performed on a patient.

43. To be GST-free, the dental profession must accept that the service is necessary and acceptable treatment, taking into account the patient's individual circumstances.

44. Services provided in assessing a patient for insurance or litigation purposes, that is, medico-legal services, are not 'necessary for the appropriate treatment' of the patient and are not GST-free.

45. Services which are predominantly for the improvement of the appearance of the patient are also not 'necessary for the appropriate treatment' of the patient and therefore, are not GST-free.

46. Services that are intended to improve the health of the patient but which also comprise a 'cosmetic' component, for example, reconstruction of a badly damaged tooth, are 'necessary for the appropriate treatment' of the patient and are therefore, GST-free.

47. A modification to a denture or other appliance undertaken for the changing condition of the patient is appropriate treatment of that patient and is GST-free if supplied by a dentist to a patient. The 'changing condition of the patient' will include situations such as:

·
an addition to the denture where the patient has had a tooth extracted; or
·
a modification or adjustment to a denture due to a change in the shape or structure of a patient's mouth, palate, gums or jaw.

48. Services for determining that a modification is required and any subsequent services to ensure that the denture fits correctly are also GST-free if the elements of section 38-10 are satisfied.

Who is the 'recipient of the supply'?

49. Paragraph 38-10(1)(c) requires that the supply must be generally accepted in the profession associated with supplying services of that kind as being 'necessary for the appropriate treatment of the recipient of the supply'.

50. As only an individual can receive treatment as a patient, the 'recipient of the supply' must be an individual for the supply to be GST-free under section 38-10.

Supply of dental services under arrangements with third parties

51. In some cases, dentists will have agreements with third parties under which there is a binding obligation on the dentist to provide something to the patient for which the third party is liable to pay. In these cases, the third party is the recipient of the supply. Depending on the particular agreement, the dentist may be making supplies to the patient as well as the third party.[3]

52. In the absence of a binding obligation, there may still be a supply by the dentist to the third party where the following factors[4] are present:

(a)
there is a pre-existing framework or agreement between the third party and the dentist which contemplates that the parties act in a particular manner in respect of supplies by the dentist to particular patients or a class of patients;
(b)
the pre-existing framework or agreement:

(i)
identifies a mechanism by which the particular patients or the class of patients are to be identified such that the supplies made to them come within the scope of the framework or agreement; and
(ii)
specifies that the third party is under an obligation to pay the dentist if there is a relevant supply by the dentist to a patient and also sets out a mechanism by which such payment is authorised;

(c)
the framework or agreement and the mechanism for authorising the payment are in existence before the supply by the dentist to the patient (that is, the dentist knows in advance that the third party is obliged to pay some or all of the consideration in the event of the supply to the patient);
(d)
the dentist makes the supply to the patient in conformity with the pre-existing framework or agreement between the parties; and
(e)
the obligation of the third party to make payment pursuant to the pre-existing framework or agreement is not an administrative arrangement to pay on behalf of the patient for a liability owed by the patient to the dentist. Rather, once the supply becomes a supply to which the framework or agreement applies, the framework or agreement establishes a liability owed by the third party (not the patient) to the dentist in the event that there is a supply by the dentist to the patient.

53. Under section 38-60, where the third party is an insurer, an operator of a statutory compensation scheme or compulsory third party scheme (scheme operator), or an Australian government agency, the supply to the third party by the dentist is GST-free to the extent that the underlying supply of the dental service to the patient is a GST-free supply under section 38-10 or 38-7.

54. Under subsection 38-60(4), the dentist and the third party can agree that the supply not be treated as GST-free. The dentist and third party may choose to not treat supplies as GST-free where, for example, there is a combination of GST-free and taxable supplies and determining the amounts for each supply may be complex. The option of not treating any of the supplies as GST-free may be administratively easier for the parties.

55. Where a third party is not an insurer, a scheme operator or an Australian government agency, the supply to the third party is not a GST-free supply under section 38-60.

Example 1 - supply of health services by a dentist to an insurer

56. ABC Health Fund has a pre-existing agreement with a dentist for the supply of goods and services to settle claims made under their insurance policies.

57. The agreement outlines what both parties need to do when the dentist treats an ABC Health Fund member. Under the agreement, the payment to the dentist from ABC health Fund is for the supply made by the dentist to ABC Health Fund for supplying dental treatment to the ABC Health Fund member.

58. As the supply of the dental treatment to the ABC Health Fund member is a GST-free supply under section 38-10, the supply by the dentist to ABC Health Fund is GST-free under section 38-60.

Example 2 - supply of health services by a dentist to a third party not being an insurer, a scheme operator or an Australian government agency

59. XYZ Company contracts with a dentist to provide dental treatment to its employees. XYZ Company is not an insurer, a scheme operator or an Australian government agency.

60. XYZ Company is the recipient of the supply of professional services from the dentist. If the dentist is registered for GST, the supply of the services is a taxable supply.

61. Section 38-60 does not apply in this scenario to make the supply to the third party GST-free because XYZ Company is not an insurer, a scheme operator or an Australian government agency.

Supplies paid for by someone other than the patient

62. Under other types of arrangements, a third party meets the patient's liability to the dentist without a supply being made to the third party by the dentist. A feature of these arrangements is that the agreement for the supply of goods or services is between the dentist and the patient and the obligation to pay for that supply remains with the patient. The third party merely pays for the supply on behalf of the patient.

63. Who pays for a supply of services is not relevant when working out if the supply is GST-free. If the recipient of the supply is the patient, it does not matter that the supply is being paid for on the patient's behalf by a third party.[5]

Example 3 - the third party merely pays for the supply of dental treatment on a patient's behalf

64. Jenny is a dentist who is a 'recognised professional' for GST purposes. Adam makes an appointment to see Jenny. At the initial consultation, Adam tells Jenny that he sustained damage to his tooth whilst at work and that she can bill his employer for the costs. Jenny confirms with Adam's employer that she can send the bill to them.

65. Jenny does not have a pre-existing agreement or a binding obligation with Adam's employer to provide the treatment to Adam.

66. Jenny is making a GST-free supply to Adam which is paid for by Adam's employer. Jenny is not making any supply to Adam's employer - they are merely paying the bill on Adam's behalf. The fact that another entity pays for the service does not alter its GST-free status.

67. Goods and Services Tax Ruling GSTR 2006/9 (Supplies), at paragraphs 114-246, provides detailed guidance in analysing third party arrangements for determining who the recipient of a supply is.

Dental goods - subsections 38-7(3) and 38-10(3)

68. If a dentist supplies goods as part of a GST-free service, those goods are also GST-free under subsection 38-7(3) or 38-10(3) if they are supplied to the patient in the course of supplying a dental service and the supply is made at the premises at which the service is supplied.

69. The phrase 'in the course of supplying' means that the goods are supplied at the same time as the dental service and they are:

·
individually customised or manipulated for the treatment of the illness or disability of that particular patient; or
·
essential for treating that patient during that particular consultation.

Supplies of medical aids and appliances under section 38-45

Medical aids and appliances - subsection 38-45(1)

70. Subsection 38-45(1) states:


A supply is GST-free if:

(a)
it is covered by Schedule 3 (medical aids and appliances), or specified in the regulations; and
(b)
the thing supplied is specifically designed for people with an illness or disability, and is not widely used by people without an illness or disability.

71. A supply that satisfies all the requirements in subsection 38-45(1) is GST-free. The supply is GST-free no matter who makes the supply or who the supply is made to.

72. In determining whether a medical aid or appliance is specifically designed for people with an illness or disability, reference should be made to its features and the designer's or manufacturer's intention of how the good is to be used. Indicators of the designer's or manufacturer's intention of how the good is to be used include how the good is marketed and the type of retail outlets at which the goods can be purchased.

73. In determining whether a medical aid or appliance is widely used by people without an illness or disability, reference should be made to how the wider community uses these goods. That is, the common purpose for which the goods are purchased. Subsection 38-45(1) does not require the medical aid or appliance to be used in a particular way but rather focuses on the purpose for which the wider community purchases these products. Irregular or uncommon use of a medical aid or appliance in a way contrary to its manufactured purpose does not prevent the good from being GST-free.

74. The items in the table in Schedule 3 to the GST Act that are of relevance to the dental industry are:

·
item 29 - 'customised toothbrushes for people with disabilities'
·
item 30 - 'dentures and artificial teeth', and
·
item 75 - 'mandibular advancement splints'.

75. For GST purposes, 'customised toothbrushes for people with disabilities' are considered to be toothbrushes that have been adapted, for example, contoured, to suit the needs of a class of disabled persons.

76. 'Dentures' for GST purposes, are considered to be an artificial restoration of several teeth (partial denture) or all of the teeth of either jaw (full denture). 'Artificial teeth' are considered to be those which are fabricated and replace natural teeth in form and function. The phrase 'artificial teeth' includes a single tooth as well as multiple teeth. Full crowns and bridges are artificial teeth.

77. A 'mandibular advancement splint' is a small device made of plastic or similar material that is worn in the mouth whilst sleeping (similar in appearance to a mouthguard). It is designed to help stop some types of snoring. The splint is designed to push the mandible (lower jaw) forward helping to keep the tongue clear of the pharynx (the back of the throat). The splints are also sometimes used for the treatment of temporomandibular joint disorder (TMJ).

Consumables

78. Where, in the course of supplying one of the products listed at item 28, item 30 or item 75 in the table in Schedule 3, a dentist consumes various things, there is only one overall supply of the listed item. Things made and consumed in the process of constructing and supplying a listed item form part of the one overall GST-free supply of that product, even if the components are separately itemised in the bill.

79. Examples of things consumed in the process of constructing and supplying a GST-free medical aid or appliance include oil, lubricant, glue and generic parts like screws and wires. Consumable items are acquired with the intention that they will be destroyed, consumed or expended. They do not retain their individual character or nature when a new medical aid or appliance is supplied or when a repaired medical aid or appliance is returned to its owner.

80. However, where these things are supplied separately to the medical aid or appliance, they are only GST-free if they are specifically designed spare parts of that medical aid or appliance (see paragraphs 82 to 84 of this Class Ruling).

Example 4 - goods used or consumed in the process of constructing and supplying a GST-free medical aid or appliance

81. Steve (a dentist) contracts Mike (a dental technician) to make a crown for Steve's patient. In order to make the crown, Mike must first create a plaster model. Mike itemises the crown and plaster model separately on his bill to Steve. The plaster model is integral to the manufacturing process and is not used for any other purpose. The plaster model forms part of the overall supply of the crown, all of which is GST-free. Goods made and consumed in the process of constructing and supplying a GST-free medical aid or appliance form part of the overall GST-free supply of that item.

Spare parts for GST-free medical aids and appliances - subsection 38-45(2)

82. Under subsection 38-45(2), a spare part for a GST-free medical aid or appliance is also GST-free if is specifically designed as a spare part for that GST-free medical aid or appliance and is supplied for that purpose.

83. For GST purposes, a 'spare part' is a part that can be used to replace a faulty, worn or broken part of another thing. The part need only be capable of replacing the faulty, worn or broken part. It does not actually have to be used for that purpose.

84. Spare parts that are not specifically designed to replace a faulty, worn or broken part of a GST-free medical aid or appliance are not GST-free. This means that things like generic screws which are not specifically designed for a GST-free medical aid or appliance are not GST-free spare parts. However, as explained in paragraphs 78 to 80 of this Class Ruling, things used and or consumed in the construction and overall supply of a GST-free medical aid or appliance are part of that overall GST-free supply. Therefore, whilst a generic screw when supplied on its own is not a GST-free spare part for a denture because it is not specifically designed for that purpose, it would be GST-free if that screw formed part of the supply of the denture.

Example 5 - a part that cannot be used as a spare part for a GST-free medical aid or appliance

85. A chrome/cobalt casting frame is the internal framework for a denture. Dentures are covered by item 30 in the table in Schedule 3 and are GST-free. Whilst the framework is a component for a denture, it is not a 'spare part' for a denture. This is because if the framework is broken, it is either repaired or a completely new denture is supplied. A new framework is never actually supplied to replace a faulty, worn or broken framework of the denture. Therefore, it is not a GST-free spare part.

Repair services

86. Other than repairs of dental goods which may be GST-free under section 38-7 (see paragraphs 31 to 34 above), there is no specific exemption in the GST Act for the supply of repairs of medical aids or appliances or their spare parts.

Supply of spare parts with labour services

87. Where the specifically designed spare parts are supplied together with a labour component (for example, installation or fitting service) that is not GST-free, the GST treatment will depend on how the supply is characterised. The table below provides a summary of how the supply may be characterised.

What is the character of the supply?

Type Dominant component Integral, ancillary or incidental component GST outcome
A Specifically designed spare parts Labour A single composite GST-free supply of specifically designed spare parts
B Labour (not GST-free) Specifically designed spare parts A single composite taxable supply of labour
C Separately identifiable supplies of spare parts and labour Neither is integral, ancillary or incidental to the other A partly taxable and partly GST-free supply (a mixed supply). The taxable component is the labour and the GST-free component is the specifically designed spare part. A reasonable basis must be used for apportionment

What does integral, ancillary or incidental mean?

88. Indicators[6] that a part of a supply is integral, ancillary or incidental to the dominant part of the supply include the following:

·
it represents a marginal proportion of the total value of the package compared to the dominant part
·
it is necessary or contributes to the supply as a whole but cannot be identified as the dominant part of the supply
·
it contributes to the proper performance of the contract to supply the dominant part, and
·
a supplier would reasonably conclude that it does not constitute for customers an aim in itself but is a means of better enjoying the dominant thing supplied.

Example 6 - GST-free supply of spare parts to which labour is integral, ancillary or incidental

89. A tooth is fitted to a denture to replace a broken or missing tooth under a 'supply and fit' contract. The supply of the tooth itself is GST-free under section 38-7or section 38-10. The fitting of the tooth is merely integral, ancillary or incidental to the supply of the tooth. The fitting of the tooth and the supply of the tooth is a single composite GST-free supply of an 'artificial tooth'. See Type A in the table in paragraph 87 of this Class Ruling.

Example 7 - taxable supply of labour to which the spare parts are integral, ancillary or incidental

90. A denture is in poor condition and is sent to be restored which involves a significant amount of labour. The restoration service is not GST-free under section 38-7 as no medicare benefit is payable for the service. As part of that restoration, a clasp is replaced. Of itself, the clasp is a GST-free spare part for a denture under subsection 38-45(2). However, in this case, the supply of the clasp is integral, ancillary or incidental to the supply of the restoration service which is not GST-free. The supply of the clasp merely contributes to the proper performance of the contract to restore the denture, takes up a marginal proportion of the total value of the service package, and the customer does not seek the supply of the clasp as an aim in itself, but merely as part of the supply of the restoration service. The supply of the restoration service and the spare part is a single composite taxable supply. See Type B in the table in paragraph 87 of this Class Ruling.

Example 8 - Partly taxable and partly GST-free supply of spare parts and labour as neither component is integral, ancillary or incidental to each other

91. A tooth is added to a denture to replace a broken or missing tooth under a 'supply and fit' contract. At the same time, a small crack which is discovered in the denture base is repaired. This repair service is not GST-free under section 38-7 as no medicare benefit is payable for the service. An extra charge is made for the repair of the crack. Neither the repair of the crack nor the fitted tooth is integral, incidental or ancillary to each other. The fitted tooth part of the supply is GST-free under section 38-10 and the repair part is taxable. The supply is partly taxable and partly GST-free. See Type C in the table in paragraph 87 of this Class Ruling.

Apportionment

A supply that is partly taxable and partly GST-free

92. Where a dentist makes a supply which is partly taxable and partly GST-free (a mixed supply), the dentist will need to apportion the consideration charged for the supply between the GST-free and taxable parts pursuant to section 9-80.

93. A reasonable basis for apportionment must be used and each case must be determined on its own facts. Records must be kept that explain the method of apportionment used. Goods and Services Tax Ruling GSTR 2001/8 gives further guidance on mixed supplies and apportionment.

94. As a means of minimising compliance costs, part of a supply may be treated as being integral, ancillary or incidental to the other part if the consideration that would be apportioned to it (if it were part of a mixed supply) does not exceed the lesser of:

·
$3.00; or
·
20% of the consideration of the total supply.

95. This approach may be adopted to treat a supply as a composite supply (that is, either wholly GST-free or taxable), although it might otherwise be considered as a mixed supply. However, if the consideration for a part exceeds the lesser of $3.00 or 20% of the consideration for the total supply, it does not necessarily mean that the part is not integral, ancillary or incidental.

Charging GST on a GST-free medical aid or appliance or a specifically designed spare part

96. In some circumstances, it may be difficult to determine those supplies that are GST-free and those that are taxable.

97. Subsection 38-45(3) allows a supplier and recipient to agree not to treat supplies, or a particular supply, as GST-free. For example, if a supply of a medical aid or appliance is made to another business, both businesses can agree to treat the supply as taxable.

Appendix 2 - Detailed contents list

98. The following is a detailed contents list for this Ruling:

Paragraph
What this Ruling is about 1
Relevant provision(s) 2
Class of entities 3
Qualifications 5
Date of effect 9
Scheme 10
Ruling 15
Supplies made by dentists under section 38-7 16
Supplies of services 16
Supplies of goods to patients (goods other than medical aids and appliances covered by section 38-45) 17
Supplies made by dentists under section 38-10 18
Supplies of services 18
Supplies of goods to patients (goods other than medical aids and appliances covered by section 38-45) 19
Supplies of medical aids and appliances under section 38-45 20
Supplies of medical aids and appliances used in the dental Industry 20
Supplies of specifically designed spare parts for medical aids and appliances 21
Supplies of specifically designed spare parts with labour services 23
Appendix 1 - Explanation 26
Taxable supplies - section 9-5 28
GST-free supplies under section 38-7 31
GST-free supplies under section 38-10 35
Dental services - subsection 38-10(1) 35
Paragraph 38-10(1)(a) 37
Are dental services specified in the table or the regulations? 37
Paragraph 38-10(1)(b) 38
Who is a recognised professional in relation to the supply of dental services? 38
Paragraph 38-10(1)(c) 40
What is 'appropriate treatment'? 41
Who is the 'recipient of the supply'? 49
Supply of dental services under arrangements with third parties 51
Example 1 - supply of health services by a dentist to an insurer 56
Example 2 - supply of health services by a dentist to a third party not being an insurer, a scheme operator or an Australian government agency 59
Supplies paid for by someone other than the patient 62
Example 3 - the third party merely pays for the supply of dental treatment on a patient's behalf dental treatment on a patient's behalf 64
Dental goods - subsections 38-7(3) and 38-10(3) 68
Supplies of medical aids and appliances under section 38-45 70
Medical aids and appliances - subsection 38-45(1) 70
Consumables 78
Example 4 - goods used or consumed in the process of constructing and supplying a GST-free medical aid or appliance 81
Spare parts for GST-free medical aids and appliances - subsection 38-45(2) 82
Example 5 - a part that cannot be used as a spare part for a GST-free medical aid or appliance 85
Repair services 86
Supply of spare parts with labour services 87
What does integral, ancillary or incidental mean? 88
Example 6 - GST-free supply of spare parts to which labour is integral, ancillary or incidental 89
Example 7 - taxable supply of labour to which the spare parts are integral, ancillary or incidental 90
Example 8 - Partly taxable and partly GST-free supply of spare parts and labour as neither component is integral, ancillary or incidental to each other 91
Apportionment 92
A supply that is partly taxable and partly GST-free 92
Charging GST on a GST-free medical aid or appliance or a specifically designed spare part 96
Appendix 2 - Detailed contents list 98
Attachment A Page 23

Attachment A

Unless specifically stated, it is assumed that the recipient of all of these supplies is the patient.

Supplies that are GST-free are GST-free under section 38-7, section 38-10 or section 38-45, as applicable.

Item GST Status Notes
Diagnostic Services - examinations
011 Comprehensive oral examination - a comprehensive evaluation and recording of the current status of the dentition, mouth and associated structures. This applies to new patients; established patients who have had a significant change in health conditions or established patients who have been absent from active treatment for two or more years. This may require interpretation of information acquired through additional diagnostic procedures reported and itemised separately. This evaluation includes recording an appropriate oral and medical history and any other relevant information. GST-free (see Notes for exception) #
012 Periodic oral examination - an evaluation of the dentition, mouth and associated structures performed on a patient of record to determine any changes in the patient's oral and medical health status since a previous comprehensive or periodic examination. This may require interpretation of information acquired through additional diagnostic procedures reported and itemised separately. GST-free
013 Oral examination - limited - a limited evaluation of the dentition, mouth and associated structures performed on a patient. This may be for a specific oral health problem or complaint. This may require interpretation of information acquired through additional diagnostic procedures reported and itemised separately. This evaluation includes recording an appropriate oral and medical history and any other relevant information. GST-free
014 Consultation - a consultation to seek advice or discuss treatment options regarding a specific dental or oral condition. This consultation includes recording an appropriate medical history and any other relevant information. GST-free (see Notes for exception) #
015 Consultation - extended (30 minutes or more) - an extended consultation to seek advice or discuss treatment options regarding a specific dental or oral complaint. This consultation includes recording an appropriate medical history and any other relevant information. GST-free (see Notes for exception) #
016 Consultation by referral - a consultation with a patient referred by a dental or medical practitioner for an opinion or management of a specific dental disorder. This consultation may not necessarily be with a specialist. The referring practitioner should be provided with a report from the consultant, included within the item number. GST-free (see Notes for exception) #
017 Consultation by referral - extended (30 minutes or more) - an extended consultation with a patient referred by a dental or medical practitioner for an opinion or management of a specific dental disorder. This consultation may not necessarily be with a specialist. The referring practitioner should be provided with a report from the consultant, included within the item number. GST-free (see Notes for exception) #
018 Written report (not elsewhere included) - a written report not addressed to a referring practitioner involved in the patient's care. Taxable T
019 Letter of referral - a letter from a dentist referring a patient to another practitioner and providing appropriate information to the consultant. GST-free (see Notes for exception) #
Radiological Examination and Interpretation
022 Intraoral periapical or bitewing radiograph - per exposure - taking and interpreting a radiograph made with the film inside the mouth. GST-free (see Notes for exception) #
025 Intraoral radiograph - occlusal, maxillary, mandibular - per exposure - taking and interpreting an occlusal, maxillary or mandibular intraoral radiograph. This radiograph shows a more extensive view of teeth and maxillary or mandibular bone. GST-free (see Notes for exception) #
026 Cone beam volumetric tomography - scan acquisition - per appointment - acquisition of a cone beam volumetric tomography [CBVT] scan and the associated images. Reconstructed images from this scan are included in this item number. For interpretation and/or analysis see items 087, 088, 089, 090, 091.

CBVT is also referred to as CBCT.

GST-free (see Notes for exception) #
031 Extraoral radiograph - maxillary, mandibular - per exposure - taking and interpreting a radiograph of the upper and/or lower jaw using a film placed outside the mouth: for example, oblique lateral radiograph. GST-free (see Notes for exception) #
033 Lateral, antero-posterior, postero-anterior or submento-vertex radiograph of the skull - per exposure - taking and interpreting an extraoral radiograph of the head taken from the side, the front, the back or through the vertex of the skull. No cephalostat is used. GST-free (see Notes for exception) #
035 Radiograph of temporomandibular joint - per exposure - taking and interpreting a radiograph of the temporomandibular joint. GST-free (see Notes for exception) #
036 Cephalometric radiograph - lateral, antero-posterior, postero-anterior or submento-vertex - per exposure - taking and interpreting a radiograph of the head taken from the side, the front, the back or through the vertex of the skull for the purpose of measurement and analysis. A cephalostat is used to standardise the conditions of imaging. GST-free (see Notes for exception) #
037 Panoramic radiograph - per exposure - taking and interpreting an extraoral radiograph presenting a panoramic view of part or all of the mandible and/or maxilla and/or adjacent structures. GST-free (see Notes for exception) #
038 Hand-wrist radiograph for skeletal age assessment - taking and interpreting and extroral radiograph of the wrist bones, used to assess the degree of skeletal development and maturity. GST-free (see Notes for exception) #
039 Computed tomography of the skull or parts thereof - a radiograph is made of a region using tomographic X-ray equipment that may produce a series of diagnostic images. A cephalostat may be used to standardise the conditions of imaging. GST-free (see Notes for exception) #
Other Diagnostic Services
041 Bacteriological examination - an examination for bacteria or other microorganisms in samples obtained from the patient. GST-free
042 Culture examination and identification - a sample is taken from oral material and is cultured for examination and identification of the microorganisms present. GST-free
043 Antibiotic sensitivity test - a laboratory procedure where a live culture of a suspected pathogen is challenged with antibiotic samples to determine the sensitivity or resistance of the microorganisms to the antibiotics tested. GST-free
044 Collection of specimen for pathology examination - the non-surgical collection and preparation for transport of a specimen for examination at a pathology laboratory. GST-free
047 Saliva screening test - taking and testing a saliva sample to assess its physiological properties. GST-free
048 Bacteriological screening test - taking and testing a sample to assess its physiological properties. GST-free
051 Biopsy of tissue - a surgical procedure to obtain a section of tissue for pathological examination. GST-free
052 Histopathological examination of tissue - a histopathological examination to determine the disease status of a section of tissue. GST-free
053 Cytological investigation - a microscopic examination of cells obtained from a smear or in situ staining of a suspected lesion to determine any aberrant characteristics that may suggest the lesion is malignant or related to some other condition. GST-free
054 Oral mucosal screening - a non-invasive test for screening of oral mucosa for oral cancer, potentially malignant lesions and/or other conditions. This may involve use of adjunctive diagnostic devises and techniques including white light reflectance, reflectance spectroscopy or auto-fluorescence. GST-free
055 Blood sample - the collection of a suitable sample of blood for haematological examination. GST-free
056 Haematological examination - the examination and reporting of the status of a blood sample. GST-free
59 Comprehensive head and neck cancer examination and risk assessment - a specific comprehensive examination that consists of visual inspection and manual palpation of extra-oral head and neck structures, intra-oral soft tissues, and may involve indirect laryngoscopy or fibre-optic pharyngo-laryngoscopy. This includes a detailed patient risk assessment. GST-free
061 Pulp testing - per appointment - a non-invasive test used to determine the clinical status of the pulp. It involves the application of external stimulation to the pulp to determine its response. Other teeth are generally tested for comparison. This procedure should only be itemised once for each visit when pulp testing is performed. GST-free
071 Diagnostic model - per model - the production of a model from an impression or digital data. The model is used for examination and treatment planning procedures. This item should not be used to describe a working model. GST-free (see Notes for exception) #
072 Photographic records - intraoral - per appointment - photographic images showing structures inside the mouth associated with dental diagnosis or clinical procedure. These images should not be confused with digitised radiographic images and must be either printed or saved electronically. GST-free (see Notes for exception) #
073 Photographic records - extraoral - per appointment - photographic images showing the face or a region of the head and neck outside the mouth, associated with dental diagnosis or clinical procedure. These images should not be confused with digitised radiographic images and must be either printed or saved electronically. GST-free (see Notes for exception) #
074 Diagnostic wax-up - the preparation and waxing up of diagnostic models to facilitate the development of a treatment plan. GST-free (see Notes for exception) #
075 Diagnostic modelling - the use of diagnostic images for simulation of treatment including, but not limited to, dental implant placement, crown and bridge work, orthognathic surgery and orthodontic tooth movement. GST-free (see Notes for exception) #
081 Cephalometric analysis - excluding radiographs - the analysis of a cephalometric radiograph (item 036) by measurement of specific biological landmarks in order to determine and predict patterns of development of the cranio-maxillofacial growth complex. The procedure is often employed in orthodontic diagnosis. GST-free (see Notes for exception) #
082 Tooth-jaw size prediction analysis - the analysis of records, including radiographs and casts, to predict the relationship between the anticipated size of the mandible, the maxilla and the teeth these bones have to accommodate. GST-free (see Notes for exception) #
083 Tomographic Analysis - the analysis of a tomography (item 039) by measurement of specific biological landmarks. The procedure is often employed in treatment planning for implant and other surgical procedures. GST-free (see Notes for exception) #
085 Electromyographic recording - utilisation of electronic apparatus to detect and record sensitivity of the orofacial and associated musculature. GST-free (see Notes for exception) #
086 Electromyographic analysis - the analysis of electromyographic recordings of the orofacial and associated musculature. GST-free (see Notes for exception) #
087 Cone beam volumetric tomography analysis and/or interpretation - small field of view (less than one complete dental arch) - the analysis and/or interpretation of a cone beam volumetric scan (refer to item 026) with a limited field of view. The procedure is often employed in diagnosis, treatment planning and analysis for dental procedures. CBVT is also known as CBCT. GST-free (see Notes for exception) #
088 Cone beam volumetric tomography analysis and/or interpretation - maxillary or mandibular dentition (single arch) - the analysis and/or interpretation of a cone beam volumetric scan (refer to item 026) of the maxillary or mandibular dentition and supporting alveolar structures. The procedure is often employed in diagnosis, treatment planning and analysis for dental procedures. CBVT is also known as CBCT. GST-free (see Notes for exception) #
089 Cone beam volumetric tomography analysis and/or interpretation - maxillary and mandibular dentition (both arches) - the analysis and/or interpretation of a cone beam volumetric scan (refer to item 026) of the maxillary and mandibular dentition and supporting alveolar structures. The procedure is often employed in diagnosis, treatment planning and analysis for dental procedures. CBVT is also known as CBCT. GST-free (see Notes for exception) #
090 Cone beam volumetric tomography analysis and/or interpretation - temporomandibular joints only - the analysis and/or interpretation of a cone beam volumetric scan (refer to item 026) of the temporomandibular joints only, including an open mouth scan if required. The procedure is often employed in diagnosis, treatment planning and analysis for dental procedures. CBVT is also known as CBCT. GST-free (see Notes for exception) #
091 Cone beam volumetric tomography analysis and/or interpretation - orofacial structures - the analysis and/or interpretation of a cone beam volumetric scan (refer to item 026) of the entire dentition and supporting alveolar structures, also including any or all of the following: temporomandibular joints, paranasal sinuses and airway, cranial base, cervical spine. The procedure is often employed in diagnosis, treatment planning and analysis for dental procedures. CBVT is also known as CBCT. GST-free (see Notes for exception) #
Preventative, Prophylactic and Bleaching Services
Dental Prophylaxis and Bleaching
111 Removal of plaque and/or stain - removal of dental plaque and/or stain from the surfaces of all teeth. This item is included in procedures described by items 114 and 115. GST-free (see Notes for exception) #
113 Recontouring and polishing of pre-existing restoration(s) - per appointment - the reshaping and polishing of pre-existing restorations. GST-free
114 Removal of calculus - first appointment - removal of calculus from the surfaces of teeth and/or implants. GST-free
115 Removal of calculus - subsequent appointment - this item describes procedures in item 114 when, because of the extent or degree of calculus, an additional appointment(s) is required to remove deposits from the teeth and/or implants. GST-free
116 Enamel micro-abrasion - per tooth - the chemo-physical removal of discoloured and/or other surface enamel defects resulting from developmental defects, altered mineralisation or decalcification of the superficial enamel layer. GST-free
117 Bleaching, internal - per tooth - the modification of the colour of the discoloured crown of an endodontically treated tooth using chemical and/or physical methods applied internally. This is a clinical course of treatment carried out exclusively in the surgery. GST-free
118 Bleaching, external - per tooth - the modification of the colour of a tooth using chemical and/or physical methods applied externally. This is a clinical course of treatment carried out exclusively in the surgery. GST-free (see Notes for exception) #
119 Bleaching, home application - per arch - the prescribed use, by a patient at home, of a custom-made tray for the application of bleaching medicaments to the patient's dentition. This procedure describes the complete course of treatment per arch. For provision of the tray and medicaments, see items 926 and 927. GST-free (see Notes for exception) #
Remineralisation Agents
121 Topical application of remineralisation and/or cariostatic agents, one treatment - application of remineralisation and/or cariostatic agents to the surfaces of the teeth. This may include activation of the agent. Not to be used as an intrinsic part of the restoration. GST-free
122 Topical remineralisation and/or cariostatic agent, home application - per arch - the prescribed use, by a patient at home, of a custom-made tray for the application of remineralisation and/or cariostatic agents to the patient's dentition. This procedure describes the complete course of treatment per arch.

For provision of the tray and medicaments or other remineralisation agents, see items 926 and 927.

GST-free

123 Concentrated remineralisation and/or cariostatic agent, application - single tooth - a procedure to promote caries resistance in a specific situation, involving isolation and control of the target area and prolonged application of a concentrated fluoride or remineralisation and/or cariostatic agent. This includes necessary activation of the agent.

Not to be used as an intrinsic part of the restoration.

GST-free
Other Preventative Services
131 Dietary analysis and advice - analysis of and advice on a patient's diet to correct any dietary imbalances or deficiencies which may contribute to dental disease. GST-free
141 Oral hygiene instruction - instruction in techniques for the removal of bacterial plaque. Advice of appropriate toothpaste and medicaments may be included. GST-free
142 Tobacco counselling - the analysis and assessment of a patient's tobacco use and advice on prevention and cessation of use of tobacco aimed at reducing the patient's risk of developing tobacco-related oral diseases and conditions. GST-free
151 Provision of a mouthguard - indirect - construction of a mouthguard, using a model(s) prepared from an impression(s) of the teeth taken by or under the supervision of the clinician, and subsequently inserted. Taxable T
153 Bi-maxillary mouthguard - indirect - construction of a bi-maxillary mouthguard using models prepared from impressions of the teeth taken by or under the supervision of the clinician. Taxable T
161 Fissure and/or tooth surface sealing - per tooth - sealing of non-carious pits, fissures, smooth surfaces or cracks in a tooth with an adhesive material. Any preparation prior to application of the sealant is included in this item number. GST-free
165 Desensitising procedure - per appointment - this item describes all desensitising undertaken at a single appointment and may include a procedure to diminish or abolish the painful sensitivity and discomfort which can occur in exposed dentine. GST-free
171 Odontoplasty - per tooth - a stand-alone procedure to modify the contour of the crown of a tooth or the anatomy of the fissure of a tooth. GST-free
Periodontics
213 Treatment of acute periodontal infection - per appointment - this item describes the treatment of acute periodontal infection(s). It may include establishing drainage and the removal of calculus from the affected tooth (teeth) or implant. GST-free
221 Clinical periodontal analysis and recording - this is a special examination performed as part of the diagnosis and management of periodontal disease. The procedure consists of assessing and recording a patient's periodontal condition. GST-free
222 Root planing and subgingival curettage - per tooth - the process of planing the root surface to remove rough or contaminated cementum or dentine and may include removal of calculus, curetting the soft tissues of the periodontal pocket and removing granulation tissue.

Where calculus removal is undertaken for other teeth at the same visit that do not require root planing it is appropriate to itemise 114/115 in conjunction with teeth that have undergone root planing.

GST-free
223 Non-surgical treatment of peri-implant disease - per implant - the process of debridement using specialised instrumentation to remove the microbial biofilm from the implant and/or abutment surface and may include localised application of medicaments. GST-free
231 Gingivectomy - per tooth - the surgical removal of the soft tissue wall of the periodontal pocket or the removal of swollen, excess gingival tissue. The procedure includes the removal of calculus and root planing of the tooth. GST-free
232 Periodontal flap surgery - per tooth - incision and raising of a flap or gingival tissue to enable removal of inflammatory or granulation tissue. The procedure includes the removal of calculus and root planing of the tooth. GST-free
233 Surgical treatment of peri-implant disease - per implant - surgical access and flap elevation of the peri-implant soft tissue to access the implant surface for decontamination. The procedure includes the removal of inflammatory tissue. Grafting or regenerative materials where placed should be itemised separately. GST-free
234 Application of biologically active material - the application of a biologically active material in conjunction with periodontal surgery to enhance reattachment or regeneration. This includes material such as porcine collagen and enamel matrix derivative materials. GST-free
235 Gingival graft - per tooth, implant or extraction socket - transference or transplanting gingival or other soft tissue from a donor area in the patient's mouth to an area around a tooth, implant or extraction socket to remedy a gingival deficiency. GST-free
236 Guided tissue regeneration - per tooth or implant - a surgical technique in which a membrane is adapted over a bony defect, the tooth root or an implant. GST-free
237 Guided tissue regeneration - membrane removal - surgical procedure to remove a previously positioned membrane. GST-free
238 Periodontal flap surgery for crown lengthening - per tooth - involves a flap procedure to establish a more apical gingival margin for greater exposure of tooth structure, including reshaping of alveolar bone where required. GST-free
241 Root resection - per root - removal or amputation of one or more roots of a multi-rooted tooth with or without a portion of the crown. GST-free
242 Osseous surgery - per tooth or implant - reshaping and modifying defects and deformities in the bone supporting and surrounding the tooth or implant. This includes procedures described in item 232. The procedure includes the removal of calculus and root planing of the tooth or implant. GST-free
243 Osseous graft - per tooth or implant - a surgical procedure in which particulate bone, a synthetic substitute or other matrix, is used to replace, repair or augment alveolar bone. It may be used to repair a bony defect around a tooth or dental implant. This is in addition item numbers such as 232, 245 and 684. GST-free
244 Osseous graft - block -a surgical procedure in which a block of bone is used for augmentation of a bony ridge, secured by screws or similar devices. GST-free
245 Periodontal surgery involving one tooth - surgical intervention to aid the resolution of a localised periodontal inflammatory condition involving one tooth. The item is also used to describe pericision. GST-free
246 Maxillary sinus augmentation - trans-alveolar technique - per sinus - surgical access to the maxillary sinus via the implant osteotomy site. May involve simultaneous placement of dental implants. Grafting or regenerative materials where used should be itemised separately. GST-free
247 Maxillary sinus augmentation - lateral wall approach - per sinus - surgical access in the maxillary sinus via a lateral approach with bone grafting. May involve simultaneous placement of dental implants. Grafting or regenerative materials where used should be itemised separately. GST-free
Oral Surgery
Extractions
311 Removal of a tooth or part(s) thereof - a procedure consisting of the removal of a tooth or part(s) thereof. GST-free
314 Sectional removal of a tooth or part(s) thereof - the removal of a tooth or part(s) thereof in sections. Bone removal may be necessary. GST-free
Surgical Extractions
322 Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division - removal of a tooth or tooth fragment where an incision and the raising of a mucoperiosteal flap is required, but where removal of bone or sectioning of the tooth is not necessary to remove the tooth. GST-free
323 Surgical removal of a tooth or tooth fragment requiring removal of bone - removal of a tooth or tooth fragment where removal of bone is required after an incision and a mucoperiosteal flap is raised. GST-free
324 Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division - removal of a tooth or tooth fragment where both removal of bone and sectioning of the tooth are required after an incision and a mucoperiosteal flap raised. The tooth will be removed in sections. GST-free
Surgery for Prostheses
331 Alveolectomy - per segment - the surgical modification of the shape of a segment of the alveolar bone. GST-free
332 Ostectomy - per jaw - the surgical modification of the bony architecture of the maxilla or mandible. GST-free
337 Reduction of fibrous tuberosity - a surgical procedure involving removal of fibrous tissue from the posterior maxillary alveolar ridge in order to modify the ridge contour. GST-free
338 Reduction of flabby ridge - per segment - a surgical procedure involving removal of unsupported soft tissue from a segment or quadrant of the maxillary or mandibular alveolar ridge. GST-free
341 Removal of hyperplastic tissue - the surgical removal of an area of hyperplastic tissue from the maxillary or mandibular alveolar ridge or adjacent mucosa. GST-free
343 Repositioning of muscle attachment - the surgical repositioning of a muscle attachment to place it in a more favourable position. GST-free
344 Vestibuloplasty - the surgical deepening of the buccal or labial vestibule in the mucosa. GST-free
345 Skin or mucosal graft - a surgical procedure involving a skin or mucosal graft. GST-free
Treatment of Maxillo-facial Injuries
351 Repair of skin and subcutaneous tissue or mucous membrane - the surgical cleaning and repair of a facial skin wound in the region of the mouth or jaws, or the repair of oral mucous membrane, where the wounds involve the subcutaneous tissues. GST-free
352 Fracture of maxilla or mandible - not requiring fixation - conservative treatment of a fracture of the maxilla or mandible where there is no marked displacement or mobility of the fragments. No physical reduction or fixation is required. GST-free
353 Fracture of maxilla or mandible - with wiring of teeth or intraoral fixation - treatment of a fracture of the maxilla or mandible where interdental wiring or the application of a dental splint is indicated to provide reduction and fixation of the fragments. Where a splint is required it should be itemised. GST-free
354 Fracture of maxilla or mandible - with external fixation - treatment of a fracture of the maxilla or mandible using sets of pins inserted through the skin and into the maxillary or mandibular bone to reduce and fix the fracture. The pins are locked into a firm relationship using clamps and a supporting apparatus. GST-free
355 Fracture of zygoma - treatment of a fracture of the zygoma. GST-free
359 Fracture of the maxilla or mandible requiring open reduction - surgical treatment of a fracture of the maxilla or mandible where the fracture is exposed and reduction and fixation of the fragments are performed directly. The fragments, when reduce, may be fixed in position with wires or plates and screws. GST-free
Dislocations
361 Mandible - relocation following dislocation - relocation of the condylar head of the mandible within the temporomandibular joint fossa following its dislocation. The procedure is usually performed by manipulation. GST-free
363 Mandible - relocation requiring open operation - surgical exposure of a dislocated temporomandibular joint and its correct repositioning. GST-free
Osteotomies
365 Osteotomy - maxilla - surgical exposure and fracturing of the maxilla in predetermined planes in order to modify its form or position. GST-free
366 Osteotomy - mandible - surgical exposure and fracturing of the mandible in predetermined planes in order to modify its form or position. GST-free
General Surgical
371 Removal of tumour, cyst or scar - cutaneous, subcutaneous or in mucous membrane - the surgical removal of a tumour, cyst or scar from cutaneous or subcutaneous tissues or from mucous membrane. Pathological review may be necessary. GST-free
373 Removal of tumour, cyst or scar involving muscle, bone or other deep tissue - the surgical removal of a tumour, cyst or scar involving muscle, bone or other deep tissue. Pathological review may be necessary. GST-free
375 Surgery to salivary duct - a general item to describe any surgery to salivary ducts. It includes removal of stones and plastic surgery. Details of the procedure should be specified. GST-free
376 Surgery to salivary gland - a general item to describe any surgery to the salivary gland which cannot be described by another item. Details of the procedure should be specified. GST-free
377 Removal or repair of soft tissue (not elsewhere defined) - a general item to describe surgical procedures for removal or repair of soft tissues not necessarily following trauma, which cannot be described by another item. Details of the procedure should be specified. GST-free
378 Surgical removal of foreign body - the surgical removal of a foreign body impacted in tissues. GST-free
379 Marsupialisation of cyst - the treatment of a cyst by surgically opening it to convert it from an enclosed sac to a partially open pouch. GST-free
Other Surgical Procedures
381 Surgical exposure of unerupted tooth - per tooth - surgical exposure of an unerupted tooth to encourage its eruption. GST-free
382 Surgical exposure and attachment of device for orthodontic traction - surgical exposure of an unerupted tooth and attachment of a device so that orthodontic traction may be applied. GST-free
384 Repositioning of displaced tooth/teeth - per tooth - a procedure following trauma where the position of the displaced tooth/teeth is corrected by manipulation. Stabilising procedures are itemised separately. GST-free
385 Surgical repositioning of unerupted tooth - per tooth - surgical exposure and manipulation of an unerupted tooth to correct its position but not to detach the tooth from its supporting tissues. GST-free
386 Splinting of displaced tooth/teeth - per tooth - a procedure following trauma where the position of the displaced tooth/teeth may be stabilised by splinting. For removal of splint, see item 656. GST-free
387 Replantation and splinting of a tooth - per tooth - replantation of a tooth which has been avulsed or intentionally removed. It may be held in the correct position by splinting. For removal of splint see item 656. GST-free
388 Transplantation of tooth or tooth bud - surgical access to and transplantation of an unerupted tooth or tooth bud to a new position prepared in the maxilla or mandible to receive it. GST-free
389 Surgery to isolate and preserve neurovascular tissue - additional surgery performed at the time of dento-alveolar surgery where damage to the neurovascular bundle may occur. The object of the additional surgery is to isolate and protect the neurovascular bundle from injury. GST-free
391 Frenectomy - removal of a frenum. GST-free
392 Drainage of abscess - drainage and/or irrigation of an abscess other than through a root canal or at the time of extraction. The drainage may be through an incision or inserted tube. GST-free
393 Surgery involving the maxillary antrum - a general item to describe any surgery of the maxillary antrum, including lavage, antrostomy, recovery of a foreign body or closure of an oro-antral communication. Details of the procedure should be specified. GST-free
394 Surgery for osteomyelitis - a general item to describe any surgery for the treatment of osteomyelitis. Details of the procedure should be specified. GST-free
395 Repair of nerve trunk - a surgical procedure to repair a nerve trunk. GST-free
399 Control of reactionary or secondary post-operative haemorrhage - this procedure describes the control of reactionary or secondary post-operative haemorrhage. GST-free
Endodontics
Pulp and Root Canal Treatments
411 Direct pulp capping - a procedure where an exposed pulp is directly covered with a protective dressing or cement. GST-free
412 Incomplete endodontic therapy (tooth not suitable for further treatment) - a procedure where in assessing the suitability of a tooth for endodontic treatment a decision is made that the tooth is not suitable for restoration. Temporisation is itemised separately. GST-free
414 Pulpotomy - amputation within the pulp chamber of part of the vital pulp of a tooth. The pulp remaining in the canal(s) is hen covered with a protective dressing or cement. GST-free
415 Complete chemo-mechanical preparation of root canal - one canal - complete chemo-mechanical preparation including removal of pulp or necrotic debris from a canal. GST-free
416 Complete chemo-mechanical preparation of root canal - each additional canal - complete chemo-mechanical preparation including removal of pulp or necrotic debris from each additional canal of a tooth with multiple canals. GST-free
417 Root canal obturation - one canal - the filling of a root canal, following chemo-mechanical preparation. GST-free
418 Root canal obturation - each additional canal - the filling, following chemo-mechanical preparation, of each additional canal in a tooth with multiple canals. GST-free
419 Extirpation of pulp or debridement of root canal(s) - emergency or palliative - the partial or thorough removal of pulp and/or debris from the root canal system of a tooth. This is an emergency or palliative procedure distinct from visits for scheduled endodontic treatment.

Temporisation, other than the closure of an access cavity should be itemised separately.

GST-free
421 Resorbable root canal filling - primary tooth - the placement of resorbable root canal filling material in a primary tooth. GST-free
Periradicular Surgery
431 Periapical curettage - per root - surgical exposure of the apical section of the root of a pulpless or endodontically treated tooth to remove associated pathological tissue. GST-free
432 Apicectomy - per root - surgical exposure of the apical section of the root of a pulpless or endodontically treated tooth to remove the apical portion of the root including curettage of the region. GST-free
433 Exploratory periradicular surgery - surgery to investigate the integrity of the root and surrounding structures. GST-free
434 Apical seal - per canal - a surgical method of debriding and filling the apical end of the root canal of a tooth. The procedure may include apicectomy and periapical curettage. GST-free
436 Sealing of perforation - a surgical method of sealing a communication between the pulp canal/chamber and the periradicular tissues. GST-free
437 Surgical treatment and repair of external root resorption - per tooth - surgical treatment of external root resorption. GST-free
438 Hemisection - separation of a multi-rooted tooth into two parts. GST-free
Other Endodontic Services
445 Exploration and/or negotiation of a calcified canal - per canal, per appointment - chemical and physical procedures to locate and/or negotiate and abnormally calcified root canal where specific time is devoted to this procedure. GST-free
451 Removal of root filling - per canal - removal of the toot filling from a previously obturated canal to enable endodontic retreatment. GST-free
452 Removal of a cemented root canal post or post crown - removal of a cemented root canal post or post crown. GST-free
453 Removal or bypassing fractured endodontic instrument - the removal or bypassing of an instrument lodged in the root canal. GST-free
455 Additional visit for irrigation and/or dressing of the root canal system - per tooth - additional debridement irrigation and short-term dressing required where evidence of infection or inflammation persists following prior opening of the root canal and removal of its contents. GST-free
457 Obturation of resorption defect or perforation (non-surgical) - conservative treatment of a root perforation or resorption defect to repair the defect from within the root canal. GST-free
458 Interim therapeutic root filling - per tooth - a procedure consisting of the insertion of a long-term provisional (temporary) root canal filling with therapeutic properties which facilitates healing/development of the root and periradicular tissues over an extended time. GST-free
Restorative services
Direct Restorations
Metallic Restorations - Direct
511 Metallic restoration - one surface - direct - direct metallic restoration involving one surface of a tooth. GST-free
512 Metallic restoration - two surfaces - direct - direct metallic restoration involving two surfaces of a tooth. GST-free
513 Metallic restoration - three surfaces - direct - direct metallic restoration involving three surfaces of a tooth. GST-free
514 Metallic restoration - four surfaces - direct - direct metallic restoration involving four surfaces of a tooth. GST-free
515 Metallic restoration - five surfaces - direct - direct metallic restoration involving five surfaces of a tooth. GST-free
Adhesive Restorations - Anterior Teeth - Direct
521 Adhesive restoration - one surface - anterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving one surface of an anterior tooth. GST-free
522 Adhesive restoration - two surfaces - anterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving two surfaces of an anterior tooth. GST-free
523 Adhesive restoration - three surfaces - anterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving three surfaces of an anterior tooth. GST-free
524 Adhesive restoration - four surfaces - anterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving four surfaces of an anterior tooth. GST-free
525 Adhesive restoration - five surfaces - anterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving five surfaces of an anterior tooth. GST-free
526 Adhesive restoration - veneer - anterior tooth - direct - direct bonding of a veneer of adhesive tooth-coloured material to the surface of an anterior tooth. GST-free (see Notes for exception) #
Adhesive Restorations - Posterior Teeth - Direct
531 Adhesive restoration - one surface - posterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving one surface of a posterior tooth. GST-free
532 Adhesive restoration - two surfaces - posterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving two surfaces of a posterior tooth. GST-free
533 Adhesive restoration - three surfaces - posterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving three surfaces of a posterior tooth. GST-free
534 Adhesive restoration - four surfaces - posterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving four surfaces of a posterior tooth. GST-free
535 Adhesive restoration - five surfaces - posterior tooth - direct - direct restoration, using an adhesive technique and a tooth-coloured material, involving five surfaces of a posterior tooth. GST-free
536 Adhesive restoration - veneer - posterior tooth - direct - direct bonding of a veneer of adhesive tooth-coloured material to the surface of a posterior tooth. GST-free (see Notes for exception) #
Indirect Restorations
Metallic Restorations - Indirect
541 Metallic restoration - one surface - indirect - indirect metallic restoration involving one surface of a tooth. GST-free
542 Metallic restoration - two surfaces - indirect - indirect metallic restoration involving two surfaces of a tooth. GST-free
543 Metallic restoration - three surfaces - indirect - indirect metallic restoration involving three surfaces of a tooth. GST-free
544 Metallic restoration - four surfaces - indirect - indirect metallic restoration involving four surfaces of a tooth. GST-free
545 Metallic restoration - five surfaces - indirect - indirect metallic restoration involving five surfaces of a tooth. GST-free
Tooth-coloured Restorations - Indirect
551 Tooth-coloured restoration - one surface - indirect - indirect tooth-coloured restoration involving one surface of a tooth. GST-free
552 Tooth-coloured restoration - two surfaces - indirect - indirect tooth-coloured restoration involving two surfaces of a tooth. GST-free
553 Tooth-coloured restoration - three surfaces - indirect - indirect tooth-coloured restoration involving three surfaces of a tooth. GST-free
554 Tooth-coloured restoration - four surfaces - indirect - indirect tooth-coloured restoration involving four surfaces of a tooth. GST-free
555 Tooth-coloured restoration - five surfaces - indirect - indirect tooth-coloured restoration involving five surfaces of a tooth. GST-free
556 Tooth - coloured restoration - veneer - indirect - the attachment of a tooth-coloured veneer to the surface of a tooth. The veneer is constructed indirectly. GST-free (see Notes for exception) #
Other Restorative Services
571 Adaption of new restoration to existing removable prosthesis - per tooth - used in conjunction with restorative services where adaption of the new restoration is required to accommodate the seating and/or retention of an existing removable prosthesis. GST-free
572 Provisional (intermediate/temporary) restoration - per tooth - the provisional (intermediate) restoration of a tooth designed to last until the definitive restoration can be constructed or the tooth is removed. This item should only be used where the provisional (intermediate) restoration is not an intrinsic part of treatment. It does not include provisional (temporary) sealing of the access cavity during endodontic treatment or during construction of indirect restorations. GST-free
574 Metal band - the cementation of a metal band for diagnostic, protective purposes or for the placement of a provisional (intermediate) restoration. Where a provisional (intermediate) restoration is placed, item 572 may also be used. GST-free
575 Pin retention - per pin - use of a pin to aid the retention and support of direct or indirect restorations in a tooth. GST-free
577 Cusp capping - per cusp - this item is to be used in conjunction with items describing direct or indirect restorations of posterior teeth which are formed in such a manner as to restore the anatomical or functional height of a cusp. GST-free
578 Restoration of an incisal corner - per corner - this item is to be used in conjunction with items describing direct or indirect restorations of anterior teeth which are formed in such a way as to restore the anatomical or functional shape of an incisal corner. GST-free
579 Bonding of tooth fragment - the direct bonding of a tooth fragment as an alternative to placing a restoration. GST-free
586 Crown - metallic - with tooth preparation - preformed - placing a preformed metallic crown as a coronal restoration for a tooth. Where the restoration of the tooth at the same visit is required prior to placement of the crown, the use of item 627 is applicable. GST-free
587 Crown - metallic - minimal tooth preparation - preformed - placing a preformed metallic crown as a coronal restoration for a tooth and where minimal or no restoration of the tooth is required. Commonly referred to as a 'Hall' crown. GST-free
588 Crown - non-metallic - preformed - placing a preformed tooth coloured crown as a coronal restoration for a tooth. Where the restoration of the tooth at the same visit is required prior to placement of the crown, the use of item 627 is applicable. GST-free
595 Removal of indirect restoration - the removal of a currently cemented definitive indirect restoration which may be subsequently reinserted. GST-free
596 Recementing of indirect restoration - recementing a previously cemented indirect restoration. GST-free
597 Post - direct - insertion of a post into a prepared root canal to provide an anchor for an artificial crown or other restoration. GST-free
Prosthodontics
Crowns
611 Full crown - acrylic resin - indirect - an artificial crown constructed with an acrylic-based material, restoring a natural tooth. GST-free
613 Full crown - non-metallic - indirect - an artificial crown constructed of tooth-coloured material, restoring a natural tooth. GST-free
615 Full crown - veneered - indirect - an artificial crown constructed with a metallic base veneered with a tooth-coloured material, restoring a natural tooth. GST-free
618 Full crown - metallic - indirect - an artificial crown constructed of cast or milled metal, restoring a natural tooth. GST-free
625 Post and core for crown - indirect - a post and core fabricated accurately to the dimension of the prepared root canal(s) and the desired coronal anatomy to provide an anchor foundation for an artificial crown. GST-free
627 Preliminary restoration for crown - direct - a direct restoration of the remains of a tooth to provide a base for an intended indirect crown, placed at the same visit as the crown preparation. Pins and/or posts used should be itemised separately. GST-free
629 Post and root cap - indirect - a post and capping fitted to the root of a tooth. The post provides an anchor in the root canal of the tooth and the capping may provide support for an overdenture. It may incorporate a precision or magnetic attachment which should be separately itemised. GST-free
Provisional Crowns and Bridges
631 Provisional crown - per tooth - provisional restoration of a tooth with a crown which is designed to last until the definitive crown can be constructed or the tooth is removed. This item should only be used where a provisional crown is not an intrinsic part of another service. It should not be used for a provisional restoration between appointments during crown construction. GST-free
632 Provisional bridge pontic - per pontic - placement of a fixed provisional bridge pontic supported by teeth or implants designed to last until the definitive bridge can be constructed and inserted. The provisional restorations of the abutments are itemised separately as 631. The provisional implant abutments are itemised separately as 633. This item should only be used where a provisional bridge is not an intrinsic part of the treatment being provided. It should not be used for a provisional bridge between appointments during bridge construction. GST-free
633 Provisional implant abutment - per abutment - placement of a specific provisional abutment to an implant designed to last until the definitive abutment(s) are fitted. These are generally fitted to accommodate a provisional prosthesis. GST-free
634 Provisional implant restoration - per implant abutment - the provisional (temporary) restoration of an implant and is used for a variety of reasons but mainly to allow for the adequate integration of the implant fixture to the bone before the final definitive restoration is placed. It can also be used on a failing implant to extend the life of the implant and allow the patient to not have a 'gap' for any longer than necessary. It is not a repair. It may also be used where immediate loading of an implant is required for aesthetics and/or function. GST-free
Bridges
642 Bridge pontic - direct - per pontic - the direct attachment of a replacement tooth to the adjoining abutment tooth/teeth. The pontic and attachment may utilise reinforcing materials. The number of pontics should be indicated and the retainer should be appropriately itemised. GST-free
643 Bridge pontic - indirect - per pontic - the indirect provision of an artificial replacement tooth joined to a retainer(s) on an abutment tooth or osseointegrated implant. The number of pontics should be indicated and the retainer should be appropriately itemised. GST-free
644 Semi-fixed attachment - the preparation within a restoration of a mechanical lock or keyway matched by a complementary portion on a bridge or prosthetic appliance. The other components of the bridge or prosthetic appliance should be appropriately itemised. GST-free
645 Precision or magnetic attachment - incorporated as part of a restoration, a magnetic or precision retention device matched by a complementary attachment on a bridge or other prosthetic appliance. The other components of the bridge or prosthetic appliance should be appropriately itemised. For the prosthesis component, see item 735. GST-free
649 Retainer for bonded fixture - indirect - per tooth - a retainer and framework to be bonded to the abutment tooth/teeth for support of the bridge pontic(s) or a precision attachment. The number of abutment teeth involved should be indicated. GST-free
Crowns and Bridge Repairs and Other Services
651 Recementing crown or veneer - recementing a previously cemented crown/veneer. GST-free
652 Recementing bridge or splint - per abutment - recementing a previously cemented bridge or splint. GST-free
653 Rebonding of bridge or splint where retreatment of bridge surface is required - the rebonding of an enamel bonded bridge or splint which requires retreatment of the fitting service. GST-free
655 Removal of crown - the removal of a currently cemented definitive crown which may subsequently be reinserted. GST-free
656 Removal of bridge or splint - the removal of all or part of a currently cemented definitive bridge or splint which may subsequently be reinserted. GST-free
658 Repair of crown, bridge or splint - indirect - the extraoral repair of a crown, bridge or splint. GST-free unless section 38-7 does not apply @
659 Repair of crown, bridge or splint - direct - the intraoral repair of a cemented crown, bridge or splint. GST-free
Procedures for Implant Prostheses
661 Fitting of implant abutment - per abutment - fitting of the final implant abutment or the replacement of an existing abutment. GST-free
663 Removal of implant and/or retention device - the surgical removal of an implant and/or retention device. GST-free
664 Fitting of bar for denture - per abutment - a rigid bar affixed to natural tooth or osseointegrated implant abutment to provide support and retention for a dental prosthesis. The bar may incorporate retention devices and these should be itemised as 645. The retention components within the prosthesis are itemised as 735. GST-free
665 Prosthesis with resin base attached to implants - removable - per arch - a removable prosthesis carrying artificial teeth on a resin base supported by implants to which it is attached. This prosthesis is designed for self-removal. Abutments attached to implants itemised as 661, retention components within the prosthesis itemised as 735. GST-free
666 Prosthesis with metal frame attached to implants - fixed - per arch - a fixed prosthesis carrying artificial teeth on a cast or milled metal frame, supported by the implants to which it is attached and not designed for self-removal. This is inclusive of the sealing of the access to the abutment screws. Abutments attached to implants itemised as 661. GST-free
667 Prosthesis with metal frame attached to implants - removable - per arch - a removable prosthesis carrying artificial teeth on a cast, wrought or milled metal frame, supported by the implants to which it is attached. This prosthesis is designed for self-removal. Abutments attached to implants itemised as 661, retention components within the prosthesis itemized as 735. GST-free
668 Fixture or abutment screw removal and replacement - removal and replacement of fixture or abutment screw. GST-free
669 Removal and reattachment of prosthesis fixed to implant(s) - per implant - removal for maintenance of a prosthesis that is fixed to an osseointegrated implant(s) and not designed for self-removal. Access to attaching screws, disassembly and subsequent replacement are required. Repairs effected should be appropriately itemised. GST-free
671 Full crown attached to osseointegrated implant - non-metallic - indirect -an artificial crown constructed of tooth-coloured material attached to an osseointegrated implant. GST-free
672 Full crown attached to osseointegrated implant - veneered - indirect - an artificial crown constructed with a metallic base veneered with a tooth-coloured material attached to an osseointegrated implant. GST-free
673 Full crown attached to osseointegrated implant - metallic - indirect - an artificial crown constructed of cast metal attached to an osseointegrated implant. GST-free
678 Diagnostic template - a diagnostic template incorporating radio-opaque markers as reference marks for preferred implant and restoration placement where the template is not used as a surgical guide. GST-free
679 Surgical implant guide - provision of an appliance which indicates the ideal location and angulation for insertion of implants. GST-free
684 Insertion of first stage of two-stage endosseous implant - per implant - surgical insertion of an implant, made of biocompatible material, in the bone of the maxilla or mandible. The mucosa is closed over the implant for a period of some months until it is accepted by surrounding bone (osseointegration). The number of implants should be indicated. GST-free
688 Insertion of one-stage endosseous implant - per implant - surgical insertion of an implant, made of biocompatible material, in the bone of the maxilla or mandible. GST-free
689 Provisional implant - special purpose implant designed with the intention of it being removed at a later stage. GST-free
690 Provisional retention or anchorage device - special purpose retention or anchorage device attached to the jaws by screws or provisional implants, to reinforce anchorage and assist with orthodontic movements, and intended for removal when no longer required for orthodontic treatment. GST-free
691 Second stage surgery of two-stage endosseous implant - per implant - surgical access to the previously osseointegrated implant to attach a transmucosal component, usually a healing abutment. The number of implants should be indicated. Other items listed in the prosthodontics section may be directly applied in the description of implant prostheses, if appropriate. GST-free
Dentures and Denture Components
711 Complete maxillary denture - provision of a patient removable dental prosthesis replacing the natural teeth and adjacent tissues in the maxilla. GST-free
712 Complete mandibular denture - provision of a patient removable dental prosthesis replacing the natural teeth and adjacent tissues in the mandible. GST-free
713 Provisional complete maxillary denture - provision of a patient removable dental prosthesis replacing the natural teeth and adjacent tissues in the maxilla which is designed to last until the definitive denture can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 711 or 719. GST-free
714 Provisional complete mandibular denture - provision of a patient removable dental prosthesis replacing the natural teeth and adjacent tissues in the mandible which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 712 or 719. GST-free
715 Provisional complete maxillary and mandibular dentures - provision of a patient removable dental prosthesis replacing the natural teeth and adjacent tissues in both maxilla and the mandible which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 711, 712 or 719. GST-free
716 Metal palate or plate - a reinforcing cast metal section added to a resin denture base. The other denture components should be appropriately itemised. GST-free
719 Complete maxillary and mandibular dentures - provision of removable dental prostheses for the natural teeth and adjacent tissues in both the maxilla and mandible. GST-free
721 Partial maxillary denture - resin base - provision of a resin base for a patient removable dental prosthesis for the maxilla where some natural teeth remain. Other components of the denture such as teeth, rests, retainers and immediate tooth replacements should be appropriately itemised. GST-free
722 Partial mandibular denture - resin base - provision of a resin base for a patient removable dental prosthesis for the mandible where some natural teeth remain. Other components of the denture such as teeth, rests, retainers and immediate tooth replacements should be appropriately itemised. GST-free
723 Provisional partial maxillary denture - provision of a patient removable partial dental prosthesis replacing the natural teeth and adjacent tissues in the maxilla which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 721. GST-free
724 Provisional partial mandibular denture - provision of a patient removable partial dental prosthesis replacing the natural teeth and adjacent tissues in the mandible which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 722. GST-free
727 Partial maxillary denture - cast metal framework - provision of the framework for a patient removable dental prosthesis made with a cast metal on which to replace teeth from the maxilla where some natural teeth remain. Other components of the denture such as teeth, rests, retainers and immediate tooth replacements should be appropriately itemised. GST-free
728 Partial mandibular denture - cast metal framework - provision of the framework for a patient removable dental prosthesis made with a cast metal on which to replace teeth from the mandible where some natural teeth remain. Other components of the denture such as teeth, rests, retainers and immediate tooth replacements should be appropriately itemised. GST-free
730 A code number for Department of Veterans' Affairs use only GST-free
731 Retainer - per tooth - a retainer or attachment fitted to a tooth to aid retention of a partial denture. The number of retainers should be indicated. GST-free
732 Occlusal rest - per rest - a unit of a partial denture that rests upon a tooth surface to provide support for the denture. The number of rests used should be indicated. GST-free
733 Tooth/teeth (partial denture) - an item to describe each tooth added to the base of new partial denture. The number of teeth should be indicated. GST-free
734 Overlays - per tooth - an extension of a denture covering the occlusal surface of remaining teeth or deliberately retained roots. The number of overlays should be indicated. GST-free
735 Precision or magnetic denture attachment - a preformed device within a prosthesis which connects to a precision or magnetic component on a tooth or implant. For the tooth component, see item 645. For the implant component, see item 661. GST-free
736 Immediate tooth replacement - per tooth - provision within a denture to allow immediate replacement of an extracted tooth. The number of teeth so replaced should be indicated. GST-free
737 Resilient lining - provision of a resilient tissue-bearing surface for a removable prosthesis. This item may be used with the provision of new, or maintenance of pre-existing prostheses. Associated services should be separately itemised. GST-free
738 Wrought bar - a wrought bar joining sections of a partial prosthesis. GST-free
739 Metal backing - per backing - an extension of the casting of a cast metal partial denture to provide a backing for the denture tooth. The number of backings should be indicated. GST-free
Denture Maintenance
741 Adjustment of a denture - adjustment of a denture to improve comfort, function or aesthetics. This item does not apply to routine adjustments following the insertion of a new denture or the maintenance or repair of an existing denture. GST-free
743 Relining - complete denture - processed - replacement of the tissue fitting surface of a complete denture to improve its accuracy and fit. The procedure requires multiple appointments. GST-free
744 Relining - partial denture - processed - replacement of the tissue fitting surface of a partial denture to improve its accuracy and fit. The procedure requires multiple appointments. GST-free
745 Remodelling - complete denture - replacement of the resin base of a complete denture, with or without rearrangement of the teeth, to improve its accuracy and fit. The procedure requires multiple appointments. GST-free
746 Remodelling - partial denture - replacement of the resin base of a partial denture, with or without rearrangement of the teeth, to improve its accuracy and fit. The procedure requires multiple appointments. GST-free
751 Relining - complete denture - direct - addition to the tissue fitting surface of a complete denture to improve its accuracy and fit, using a self or light cured material. GST-free
752 Relining - partial denture - direct - addition to the tissue fitting surface of a partial denture to improve its accuracy and fit, using a self or light cured material. GST-free
753 Cleaning and polishing of pre-existing denture - the cleaning and polishing of a pre-existing denture not associated with any other item of maintenance or repair of the denture. GST-free unless section 38-7 does not apply @
754 Denture base modification - structural addition to a denture base to enhance aesthetics or function. GST-free
Denture Repairs
761 Re-attaching pre-existing clasp to denture - repair, insertion and adjustment of a denture involving re-attachment of a pre-existing clasp. GST-free unless section 38-7 does not apply @
762 Replacing/adding clasp to denture - per clasp - repair, insertion and adjustment of a denture involving replacement or addition of a new clasp or clasps. GST-free
763 Repairing broken base of a complete denture - repair, insertion and adjustment of a broken resin complete denture base. GST-free unless section 38-7 does not apply @
764 Repairing broken base of a partial denture - repair, insertion and adjustment of a broken resin partial denture base. GST-free unless section 38-7 does not apply @
765 Replacing/adding new tooth on denture - per tooth - repair, insertion and adjustment of a denture involving replacement with or addition of a new tooth or teeth to a previously existing denture. GST-free @
766 Reattaching existing tooth on denture - per tooth - repair, insertion and adjustment of a denture involving reattachment of a pre-existing denture tooth or teeth. GST-free (see Notes for exception) $
768 Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth - modification, insertion and adjustment of a partial denture involving an addition to accommodate the loss of a natural tooth or its coronal section. If the tooth is an immediate replacement, item 736 is applicable. GST-free
769 Repair or addition to metal casting - repair of or addition to the case metal frame of a denture. This is a complex procedure requiring the dismantling of the denture. Other complementary services should be appropriately itemised. GST-free (see Notes for exception) $
Other Prosthodontic Services
771 Tissue conditioning preparatory to impressions - per application - the provisional (temporary) lining of the tissue fitting surface of a denture with a conditioning material, to improve the health of the denture-supporting mucosa. GST-free
772 Splint - resin - indirect - a resin appliance attached to the teeth for stabilising mobile or displaced teeth. A resin splint may also be used to stabilise a fractured jaw. This item included the subsequent removal of the splint. GST-free
773 Splint - metal - indirect - a cast metal appliance bonded to the teeth to stabilise mobile or displaced teeth. Metal splints may also be used to stabilise a fractured jaw. This item includes the subsequent removal of the splint. GST-free
774 Obturator - a prosthesis attached to a denture or osseointegrated implants(s) which is used to close an opening in the palate or to replace other lost tissues. GST-free
775 Characterisation of denture base - stippling, staining, festooning or shaping rugae on the appropriate surface(s) of a denture. GST-free
776 Impression - denture repair/modification - an item to describe taking an impression where required for the repair or modification of a dental appliance. GST-free (see Notes for exception) $
777 Identification - marking a dental appliance with a patient's name or other form of enduring patient identification. GST-free (see Notes for exception) $
778 Inlay for denture tooth - provision of an inlay in a denture tooth. GST-free (see Notes for exception) $
779 Surgical guide for an immediate denture - provision of an appliance which indicates the final ridge contours following extraction of teeth prior to immediate denture insertion. GST-free
Removable Appliances
811 Passive removable appliance - per arch - a removable, one arch appliance attached to the dentition by metal clasps or similar device designed to maintain the position of the teeth in the dentition. The appliance does not provide pressure directed at tooth movement. Sometimes used following orthodontic active treatment to maintain a correction. GST-free
821 Active removable appliance - per arch - a removable, one arch appliance attached to the dentition by clasps or similar device which contains some elements capable of exerting pressure on either individual teeth or parts of the arch to achieve tooth or dental arch movement. GST-free
823 Functional orthopaedic appliance - custom fabrication - the custom fabrication on models of an appliance whose primary action involves orthopaedic change of jaw shape or relationship utilising and modifying the effect of the environmental tissues. Many are bi-maxillary appliances involving upper and lower arches. Bi-maxillary appliances are regarded as single appliances. GST-free
824 Functional orthopaedic appliance - prefabricated - a prefabricated elastomeric appliance whose primary action is to maintain or guide the positioning of teeth during eruption, and/or influence muscle activity of the mouth and lower face. It can also be used to maintain tooth position following orthodontic alignment. Many are bi-maxillary appliances involving upper and lower arches. Bi-maxillary appliances are regarded as a single appliance. GST-free
825 Sequential plastic aligners - per arch - a series of custom-made plastic aligners used to gradually move teeth. For retention appliance see items 811 and 845. GST-free
Fixed Appliances
829 Partial banding - per arch - application of bands and/or brackets to six teeth or fewer in the maxillary or mandibular arch, which can be attached to a resilient arch wire. The appliance is designed to correct either tooth position or arch form. GST-free
831 Full arch banding - per arch - application of bands and brackets for attachment of resilient arch wires to most of the teeth of the maxillary or mandibular arch to correct the position of teeth or to correct the arch form. This procedure includes ongoing adjustments and replacement of arch wires. For removal of banding see item 833. For retention appliances see items 811 and 845. Additional orthodontic services may be necessary prior to or following full arch banding and should be separately itemised. GST-free
833 Removal of banding - per arch - the removal of the bands and/or brackets from the teeth. GST-free
841 Fixed palatal or lingual arch appliance - insertion of an appliance, fixed to the palatal or lingual aspect of the dentition by bands, frequently applied in the molar region. It is aimed at either changing or maintaining the arch form and can also be designed to straighten individual teeth. GST-free
842 Partial banding for inter-maxillary elastics (vertical and/or cross elastics) - application of bands and brackets to two or more teeth in maxillary and mandibular arches. Resilient arch wires may be attached to the brackets and also inter-maxillary elastics between the two arches. The resulting appliances are designed to correct the position of teeth or arch form. GST-free
843 Maxillary expansion appliance - per arch - insertion of an appliance fixed to the maxillary dentition by partial banding which exerts a force to expand or widen the maxillary arch and/or teeth. GST-free
845 Passive appliance - fixed - a passive appliance fixed to one or more teeth, designed to prevent movement of the teeth relative to each other or to the segment of the arch. The appliance can be used to maintain a space from the loss of a tooth. Fixed passive appliances may be used following active orthodontic treatment. GST-free
846 Minor tooth guidance - fixed - a procedure using an appliance attached directly to teeth which provides movement or guidance to correct the position of a tooth. GST-free
Extraoral Appliances
851 Extraoral appliance - this item describes a number of appliances worn extraorally. Some appliances are worn to correct mandibular protrusion and are not attached directly to the dentition. Other appliances in this category are attached to the dentition by either full or partial banding. Most of these appliances have a harness which is passed behind the head to the front of the face to provide stabilisation for the forces applied. They are usually worn for a limited time each day. GST-free
Attachments
862 Bonding of attachment for application of orthodontic force - the bonding of a pre-fabricated attachment on a malpositioned tooth to facilitate orthodontic force application. The force application may utilise either fixed or removable appliances. This item should not be used to describe bracket attachment required by partial or full arch banding (item 829 or 831). Nor does it apply in conjunction with surgical exposure. The appropriate item in this case is item 382. GST-free
Other Orthodontic Services
871 Orthodontic adjustment - adjustment of an orthodontic appliance, either fixed or removable. This is often associated with ongoing treatment anticipated at the time of insertion of the appliance. This item should not be used with item 881. GST-free
872 Re-attachment of passive appliance - fixed - the re-attachment of a passive fixed appliance which may include any necessary cleaning or polishing of the appliance and or teeth to which it is attached or bonded. GST-free
873 Repair of passive appliance - fixed - the repair of a fixed passive appliance. This includes the removal and subsequent re-fitting of the appliance. Where an impression is required it should be appropriately itemised. GST-free (see Notes for exception) $
874 Removal of passive appliance - fixed - the removal of a passive fixed appliance and the necessary cleaning of the teeth to which it was attached. GST-free
875 Repair of removable appliance - resin base - repair of resin base of a removable appliance. Where an impression is required it should be appropriately itemised. Taxable T
876 Repair of removable appliance - clasp, spring or tooth - repair or replacement of a clasp, spring or tooth on a removable appliance. Where an impression is required, it should be appropriately itemised. GST-free (see Notes for exception) $
877 Addition to removable appliance - clasp, spring or tooth - addition of a clasp, spring or tooth to a removable appliance. Where an impression is required, it should be appropriately itemised. GST-free
878 Relining - removable appliance - processed - replacement of the tissue fitting surface of a removable appliance to improve its accuracy and fit. GST-free
881 Complete course of orthodontic treatment - this is an alternative system of coding encompassing all visits subsequent to orthodontic diagnosis and treatment planning. The item refers to a complex course of treatment of active fixed appliance therapy in both arches and retention as required. If removable and/or fixed retention, functional appliances, headgear or any other complementary auxiliary appliances are utilised, they are an intrinsic part of this item number. If arrangements are made with a third party for sequential billing, the relevant treatment form may be used. GST-free
General Services
Emergencies
911 Palliative care - an item to describe interim care to relieve pain, infection, bleeding or other problems not associated with other treatment. GST-free
915 After hours callout - an additional item to describe provision of treatment required after hours. Treatment provided should be itemised. GST-free
916 Travel to provide services - an additional item to describe travel from the usual place of practice to provide treatment. Treatment provided should be itemised. GST-free
Drug Therapy
926 Individually made tray - medicament(s) - a tray made for the application of medicaments to the teeth or supporting tissues. GST-free (see Notes for exception) #
927 Provision of medication/medicament - an additional item to describe the actual supply, prescription or administration of appropriate medications and medicaments required for dental treatments. GST-free (see Notes for exception) #
928 Intravenous cannulation and establishment of infusion - the procedure of performing venepuncture, insertion of a cannula within the lumen of a vein and the establishment of infusion. GST-free
Anaesthesia, Sedation and Relaxation Therapy
941 Local anaesthesia - a procedure where local anaesthetic is used as a specific treatment for diagnosis or relief of pain and is not associated with other treatments. GST-free
942 Sedation - intravenous - per 30 minutes or part thereof - sedative drug(s) administered intravenously, usually in increments. The incremental administration may continue while dental treatment is being provided. GST-free
943 Sedation - inhalation - per 30 minutes or part thereof - a sedative gas mixed with oxygen is inhaled by the patient while dental treatment is being provided. GST-free
944 Relaxation therapy - therapy which does not involve the use of drugs but which induces a lowered state of mental or autonomic arousal. GST-free
945 Low level laser therapy - per appointment - low level laser therapy (LLLT), also known as biostimulation or photobiomodulation, may be used for various dental applications. GST-free
948 Dental acupuncture - per appointment - treatment by acupuncture needle insertion and/or laser, pressure or heat at specific and non-specific points where the same effect is achieved without puncture. GST-free
949 Treatment under general anaesthesia/sedation - the treatment of a patient under a general anaesthetic/sedation administered by another registered practitioner in a suitable licensed facility may require the provision of additional equipment, instruments, materials and staff by the practitioner(s) providing the dental service(s). The treatment provided should be itemised. GST-free
Occlusal Therapy
961 Minor occlusal adjustment - per appointment - the detection and correction of minor irregularities and traumatic tooth contacts. GST-free
963 Clinical occlusal analysis including muscle and joint palpation - this item consists of the recording of three separate assessments: (a)

occlusal assessment - an assessment of tooth contacts in various jaw positions, parafunctional activity, vertical dimensions, tongue posture and speech, (b)

muscle assessment - assessment by intraoral and extraoral palpation of jaw muscles, cervical muscle palpation, measurement of jaw and cervical mobility, and (c)

joint assessment - includes palpation and auscultation of the temporomandibular joints, together with assessment of joint play.

This item may be used in conjunction with other services.

GST-free (see Notes for exception) #
964 Registration and mounting of models for occlusal analysis - this item describes the clinical procedures for accurate mounting of models of the maxillary and mandibular teeth on an adjustable articulator. GST-free (see Notes for exception) #
965 Occlusal splint - an appliance made to fit over the functional surfaces of either the upper or lower teeth to relieve abnormal pressures on the temporomandibular joint, its supporting structures and associated muscles as often seen in temporomandibular dysfunction It may also be used to assist in preventing parafunctional wear of teeth.

This item also describes an appliance made to locate the dentition and the dentition and the jaws in predetermined positions when orthognathic jaw surgery is performed.

GST-free
966 Adjustment of pre-existing occlusal splint - per appointment - alterations to the occlusal or biting surface of a pre-existing occlusal splint. GST-free
967 Pantographic tracing - the clinical procedure of attaching and using a specifically designed recording apparatus to graphically record movements of the jaw. GST-free
968 Occlusal adjustment following occlusal analysis - per appointment - the adjustment of the occlusion involving either natural or artificial teeth following occlusal analysis. The use of this item implies that procedures described as items 963 and/or 964 have been performed as a preparation for the occlusal adjustment. GST-free
971 Adjunctive physical therapy for temporomandibular joint and associated structures - per appointment - application of physical therapy such as heat, other radiation or ultrasonic therapy, usually in the region of the temporomandibular joint, as part of overall therapy of the temporomandibular joint and associated structures. GST-free
972 Repair/addition - occlusal splint - the repair/addition, reinsertion and adjustment of an occlusal splint. An impression(s), if required, should be itemised. GST-free (see Notes for exception) $
Miscellaneous
981 Splinting and stabilisation - direct - per tooth - the joining of adjacent teeth to provide mutual support (where not covered by item 386). This item includes the subsequent removal of the splinting material. GST-free
982 Enamel stripping - per appointment - the removal of enamel from the interdental surfaces of a tooth/teeth to reduce width. GST-free
983 Single arch oral appliance for diagnosed snoring and obstructive snoring and sleep apnoea - on request from a specialist physician, the provision and appropriate dental supervision of a removable single arch oral appliance to assist in the treatment of assessed snoring and obstructive sleep apnoea disorders. GST-free
984 Bi-maxillary oral appliance for diagnosed snoring and obstructive snoring and sleep apnoea - on request from a specialist physician, the provision and appropriate dental supervision of a removable bi-maxillary oral appliance to assist in the treatment of assessed snoring and obstructive sleep apnoea disorders. GST-free
985 Repair/addition - snoring or sleep apnoea device - the repair/addition, reinsertion and adjustment of a snoring or sleep apnoea device. Any impression(s), if required, should be itemised. See item 776. GST-free (see Notes for exception) $
986 Post-operative care not otherwise included - in normal circumstances, dentists provide post-operative care following dental treatment. However, where a patient requires unforeseen post-operative care or is seen by a dentist who did not provide the initial treatment, this item should be used. GST-free
987 Re-contour tissue - per appointment - re-contour of oral and associated tissues not described elsewhere. GST-free (see Notes for exception) #
990 Treatment not otherwise included (specify) - an item number used to identify dental treatment not elsewhere described. Adequate written description of the service is required. GST-free (see Notes for exception) #
999 GST - this item number is for use where practice accounting systems cannot accommodate GST applicable to non-clinical components. GST

Discussion of notes in relation to the GST Status

Notes :

T Refers to services that are considered to be taxable as they are not for the 'appropriate treatment' of the patient.
# Indicates services that may not be GST-free as they may not be 'necessary for the appropriate treatment' of the patient, for example, services for medico-legal or cosmetic purposes (see paragraphs 44 and 45 of this Class Ruling).
$ These are item numbers where the description of the item covers both taxable and GST-free supplies. Refer to the discussion on 'Supply of spare parts with labour services' at paragraphs 87 to 97 of this Class Ruling.
@ The Medicare Benefits Schedule provides that a medicare benefit is payable for some dental services provided in the community to people with chronic medical conditions and complex care needs. The Medicare Benefits Schedule of Dental Services provides details of services that are covered by the Medicare items; which dental practitioners are eligible to use the dental items and which patients are eligible for these dental services. Where a medicare benefit is payable, the service is GST-free under section 38-7.

Footnotes


In this Class Ruling, when a supply is indicated as being taxable or partly taxable, it is assumed that all the requirements for a taxable supply under section 9-5 are met.


The exception in subsection 38-7(2) does not apply to the items referred to in the Schedule in Attachment A to this Class ruling. Subsection 38-7(2) provides that a supply of a medical service is not GST-free under subsection 38-7(1) if it is a supply of a professional service rendered in prescribed circumstances within the meaning of regulation 14 of the Health Insurance Regulations that are made under the Health Insurance Act 1973 (other than the prescribed circumstances set out in regulations 14(2)(ea), (f) and (g).


See for example, the case of Federal Commissioner of Taxation v Secretary to the Department of Transport (Vic) [2010] FCAFC 84; 2102 ATC 20-196.


See paragraph 221B of GSTR 2006/9 but note the difference in terminology. Here, 'third party' is used instead of 'payer', 'dentist' is used instead of 'supplier' and 'patient' is used instead of 'third party'.


Subsection 9-15(2)


See Goods and Services Tax Ruling GSTR 2001/8 for further guidance in determining whether a part of a supply is integral, ancillary or incidental to the dominant part of the supply.

Not previously issued as a draft

References

ATO references:
NO 1-4CJADZI

ISSN: 1445-2014

Legislative References:
ANTS(GST)A99 9-5
ANTS(GST)A99 9-80
ANTS(GST)A99 38-7
ANTS(GST)A99 38-7(1)
ANTS(GST)A99 38-7(2)
ANTS(GST)A99 38-7(3)
ANTS(GST)A99 38-10
ANTS(GST)A99 38-10(1)
ANTS(GST)A99 38-10(1)(a)
ANTS(GST)A99 38-10(1)(b)
ANTS(GST)A99 38-10(1)(c)
ANTS(GST)A99 38-10(3)
ANTS(GST)A99 38-45
ANTS(GST)A99 38-45(1)
ANTS(GST)A99 38-45(2)
ANTS(GST)A99 38-45(3)
ANTS(GST)A99 38-60
ANTS(GST)A99 195-1
ANTS(GST)A99 Sch 3
TAA 1953
Health Insurance Act 1973 Pt II

Case References:
Commissioner of Taxation v. Secretary to the Department of Transport (Victoria)
(2010) 188 FCR 167
[2010] FCAFC 84
2010 ATC 20-196
(2010) 76 ATR 306

CR 2013/14 history
  Date: Version: Change:
  20 February 2013 Original ruling  
You are here 30 March 2016 Consolidated ruling Addendum