27 May 2025
DVA billing and compliance essentials for dental providers
The Department of Veterans’ Affairs (DVA) has issued updated guidance to assist health providers, including dentists, in navigating its billing and advertising protocols.
Key recommendations:
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Use correct item numbers
To guarantee accurate and timely payments, ensure that all services are billed using the appropriate item numbers as specified in the DVA Fee Schedule. If you have queries about item number usage you can use the ADA’s member discussion forum “Peer” to post your question and tag @ADA Schedule & Item Number Advice for expert advice.
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Seek prior financial authorisation when required
Certain services necessitate prior approval from the DVA. Providing such services without this approval may result in non-payment.
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Adhere to advertising guidelines
While promoting services to the veteran community is encouraged, avoid terms like “free” or “endorsed by DVA” in marketing materials.
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Maintain accurate records
Keep comprehensive records, including referrals, clinical notes, and treatment plans. The DVA may audit these records to ensure compliance. See the ADAVB’s Practice Plus resource “Patient healthcare records audit” tool to self-assess your record keeping.
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Consult provider notes and fee schedules
Familiarise yourself with the DVA’s information for Dental service providers and Provider news to stay informed about billing procedures and service guidelines.
For more detailed information, refer to the full article: Helping health providers better understand DVA’s arrangements.
Summary of dental treatment guidelines for DVA providers
The DVA's "Notes for Allied Health Providers – Section 2(c) – Dental" (December 2024) outlines specific protocols for dental practitioners:
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Eligibility: Only dentists, dental specialists, or dental prosthetists registered with the Department of Human Services (DHS) at the time of service can provide treatments to entitled persons.
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Fee schedules: Dental treatments are categorised into two fee schedules:
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For dentists and dental specialists
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For dental prosthetists
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Treatment schedules:
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Schedule A: Services that generally do not require prior financial authorisation for Gold or White Card holders.
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Schedule B: Services that do require prior financial authorisation for all entitled persons.
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Schedule C: Services that may not require prior financial authorisation for Gold Card holders, but are subject to an Annual Monetary Limit (AML).
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Annual monetary limit (AML): Applies to most Schedule C items. Providers should verify if an entitled person's AML has been expended before administering treatment.
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Prior financial authorisation is required for:
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All Schedule B items.
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Services listed as requiring prior approval in the Fee Schedule for Dental Prosthetists.
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Any service not listed in the fee schedules.
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Treatment plans including Schedule C items for AML-exempt entitled persons.
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All 'Fee by Negotiation' items.
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Treatments requiring general anaesthesia.
For comprehensive details, consult the full document: Notes for Allied Health Providers – Section 2(c) – Dental (PDF).
