Service Inclusions FAQs

What is a specialist medical service?

A medical service provided by a medical practitioner who is registered with Medicare Australia as a specialist in a particular specialty.

If you are not sure if the treatment you are seeking is eligible, speak to your local PATS office.

Are all health treatments covered?

No. PATS helps give you access to specialist medical services only.

Are skin cancer clinics covered?

If you are referred by a doctor to a dermatologist  at a skin cancer clinic, you are eligible for PATS. If you are seeing a general practitioner, even one with a special interest in skin cancer, you will not be eligible for PATS.

What are some examples of health services and health treatments that PATS doesn't cover?

PATS doesn’t cover:

• the extraction of third molars (wisdom teeth) – including treatment under general anaesthetic or sedation
• orthodontic treatment (braces)
• non-surgical temporo-mandibular joint treatment (also known as the jaw joint)
• implant surgery or crown and bridge treatment
• endodontics (root canal therapy)
• periodontal (gum) surgery or treatment
• MBS items in the Allied Health and Dental Services book (10975 – 10977)
• cosmetic surgery
• complementary health treatments, such as acupuncture or herbal therapy
• physiotherapy, speech therapy, podiatry, occupational therapy and other allied health treatments.

Also see allied and dental treatment below.

What is allied health treatment?

Allied health services include physiotherapy, occupational therapy, speech pathology, clinical psychology, podiatry, dietary and nutrition services, respiratory therapy and other health care services.

Does PATS cover allied health treatments?

Not usually. PATS is designed for access to specialist medical treatment.

However there are some exceptions including:

• Appointments for cochlear implants
• Appointments for infant hearing tests
• Fitting or replacement of an artificial limb or artificial eye (not subsequent adjustments)
• Rehabilitation medicine
• Complex wheelchair assessment and review

If you need allied health treatment associated with specialist treatment, you may be able to receive an extra night or two of accommodation supported by PATS.

Does PATS cover dental treatment?

Most general dental treatments are not covered.

The main dental treatments covered by PATS are:

Dental and Oral Specialists:

• Specialists treatments covered by Oral and Maxillofacial Medicare Benefits Schedule items, including facial trauma, jaw fractures, serious dentofacial infections and oral malignancy (cancer).

• Treatment provided under the Cleft Lip and Palate Scheme.

Services for young Children under (8) years of age:

• urgent and critical dental treatment requiring general anaesthesia. This includes removal of tongue tie for a newborn baby by a specialist paediatric dentists in cases where the child is not thriving.

Services for children:

• Hospital-based management of severe dental trauma or severe dentofacial infections, such as cellulitis.

• Hospital-based dental services for children with significant medical co-morbidity or other serious conditions.

Services for Adults:

• Hospital-based dental services for adults with significant medical co-morbidity or other serious conditions.

• Dental treatment for adults with special needs requiring general anaesthesia.

 Contact your local PATS office for further information on dental treatments covered under PATS.