Medicare claim changes for bulk-billed services incl. CDBS from Sept. 2025
- Regulation
Commencing this month, bulk-billed Medicare dental claims must be submitted within one year, down from two years, to improve Medicare integrity. Practices should review their processes to ensure compliance.
Shorter timeframe for bulk billed claim submission
From 5 September 2025, dentists and other healthcare providers will need to submit bulk-billed Medicare claims within 1 year of the date of service, halving the previous 2-year limit. This change stems from amendments to the Health Insurance Act 1973 and the Dental Benefits Act 2008, aimed at improving Medicare system integrity.
What bulk billed services are affected?
The reduction applies to both paper-based and electronic claims for Medicare Benefits Schedule (MBS) and Child Dental Benefits Schedule (CDBS) services. A bulk-billed service involves the patient assigning their Medicare benefit directly to the provider, leaving no out-of-pocket cost.
Bulk billed services rendered:
- on or after 5 September 2025 may be automatically paid if claimed up to 1 year from the date of service
- before 5 September 2025 may be automatically paid if claimed up to 2 years from the date of service
Providers can still apply for late lodgement exceptions beyond these timeframes under existing arrangements.
What does this mean for dentists?
Most dental claims are already submitted within 1 year, so this change should have minimal direct impact on practice operations. However, it is crucial for dental practices to be aware and ensure claims are lodged promptly to avoid delays or denials.
Providers are encouraged to review processes to ensure compliance with the new timeframe.
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