Acts and Regulations

84-115 - General

Table of contents
Full text
NEW BRUNSWICK
REGULATION 84-115
under the
Health Services Act
(O.C. 84-447)
Filed June 1, 1984
Under section 11 of the Health Services Act, the Lieutenant-Governor in Council makes the following Regulation:
1This Regulation may be cited as the General Regulation - Health Services Act.
2In this Regulation
“beneficiary” means
(a) a person in need, other than a dependent of a beneficiary, to whom a valid health services card has been issued under the Family Income Security Act and regulations,
(b) a child who is a child in the care of the Minister of Social Development under the Family Services Act and regulations to whom a valid health services card has been issued,
(c) a person who is blind or disabled as defined in the Family Income Security Act and regulations to whom a valid health services card has been issued, or
(d) a person in need who is a resident of a licenced nursing home and to whom the Minister of Social Development has issued a valid health services card;
“cosmetic drug” Repealed: 92-40
“dental practitioner” means a dental practitioner duly registered and licensed in the jurisdiction in which entitled services were provided;
“denturist” means a denturist duly registered and licensed in the jurisdiction in which entitled services were provided;
“dependent” means
(a) a spouse of a beneficiary or a dependent child under eighteen years who is not self supporting, or
(b) a person eighteen years or older who is solely dependent on a beneficiary;
“diagnostic services” means the following services performed by a dental practitioner:
(a) oral examination,
(b) single periapical or bitewing film,
(c) each additional film, and
(d) panorex X-ray;
“Director” means the person designated by the Minister to perform the duties, functions, tasks and to assume the responsibilities allocated to the Director by this Regulation;
“dispensing physician” means a medical practitioner who dispenses drugs as designated from time to time;
“emergency services” means the following services performed by a dental practitioner:
(a) extractions as a result of pain,
(b) temporary treatment of abscesses, acute necrotic ulcerative gingivitis and post-extraction complications including hemorrhage or dry socket,
(c) temporary treatment for teeth fractured as the result of an accidental injury including light cured and acid etched restorations,
(d) palliative treatment for conditions causing pain including temporary restorations, and
(e) denture repairs as limited to items listed in section 6 of Schedule II;
“entitled services” means and includes
(a) those goods or services for which a rate of payment is set out in Schedule II of this Regulation, and
(b) such other goods and services as the Minister may in sole discretion deem advisable to include within the health services plan,
but excludes those goods and services which by virtue of the Health Services Act and this Regulation and Schedule I hereto are specified as not being entitled services;
“hospital facility” means a hospital facility that is licensed or approved to provide in-patient or out-patient treatment services by the governmental licensing authority in whose jurisdiction the hospital facility is situated;
“medical practitioner” means a medical practitioner duly registered and licensed in the jurisdiction in which entitled services were provided;
“nursing service” means the Victorian Order of Nurses or the Red Cross nursing service or any other nursing service which in the opinion of the Director provides a similar service;
“optician” means an optician duly registered and licensed in the jurisdiction in which services were provided;
“optometrist” means an optometrist duly registered and licensed in the jurisdiction in which entitled services were provided;
“pharmacist” means a pharmacist duly registered and licensed in the jurisdiction in which entitled services were provided;
“prosthetic services” means the following services performed by a dental practitioner or denturist:
(a) complete dentures,
(b) removable partial dentures, and
(c) denture repairs and relines;
“special educational facility” means an institution which in the opinion of the Director provides training and rehabilitation facilities not otherwise available in New Brunswick;
“suppliers of prostheses” means retail or wholesale suppliers of prosthetic appliances;
“wholesale optical company” means a wholesale supplier of vision goods and services.
84-235; 85-61; 87-27; 89-18; 92-40; 93-26; 96-23; 2000, c.26, s.152; 2008, c.6, s.25
3(1)Every beneficiary or dependent is eligible to receive payment or have payment made on behalf of the beneficiary or dependent at the applicable rate established in Schedule II hereof, or at the amount charged, whichever is lesser, for or with respect to entitled services received in the Province.
3(2)Every beneficiary or dependent who is temporarily absent from the Province is eligible to receive payment or have payment made on behalf of the beneficiary or dependent at the rate established in Schedule II hereof, or at the amount charged, whichever is the lesser, for or with respect to the entitled services received, provided that the entitled services
(a) are required for treatment of an emergency condition due to a sudden attack of illness or for emergency treatment of an accidental injury during temporary absence from the Province,
(b) are defined by the Director as not available in the Province,
(c) have received prior approval in accordance with section 6,
(d) are supplied to a person who fulfills the requirements of paragraph (3)(b),
(e) are supplied to a person who fulfills the requirements of paragraph (3)(c), or
(f) are provided in areas of provinces and states bordering on New Brunswick designated by the Director.
3(3)For the purpose of this section a person is “temporarily absent from the Province” where that person is absent from New Brunswick for the purpose of a vacation or a visit but not where the period of absence exceeds three consecutive months, except
(a) where the beneficiary or dependent is unable to return to the Province within three months due to continued hospitalization or medical treatment of illness,
(b) where the beneficiary or dependent is living with foster parents who reside outside New Brunswick, or
(c) where the beneficiary or dependent of a beneficiary is attending a special educational facility outside New Brunswick.
3(4)Notwithstanding subsections (2) and (3), only a beneficiary or a dependent of a beneficiary
(a) who is living with foster parents who reside outside New Brunswick, or
(b) who is attending a special educational facility outside New Brunswick,
is eligible to receive payment or have payment made on his or her behalf at the rate set out in section 18 of Schedule II for entitled services provided by a denturist outside the Province.
4Notwithstanding section 3, the entitled dental services available to social assistance beneficiaries and dependents who are eighteen years of age or older and who are not in receipt of social assistance benefits as a blind or disabled person under the Family Income Security Act or are not children in care under the Family Services Act shall be limited to
(a) diagnostic services;
(b) emergency services;
(c) prosthetic services; and
(d) restorative services as listed in paragraphs 3(a) to (f) of Schedule II.
84-235; 85-61; 96-23; 2008-77
4.1Repealed: 87-93
87-27; 87-93
5Notwithstanding sections 3 and 4, a person referred by the Department of Social Development to the Dental Advisory Committee may be approved by it as a beneficiary entitled to dental services listed in Schedule II.
87-27; 94-152; 2000, c.26, s.152; 2008, c.6, s.25
5.1Notwithstanding sections 3, 4 and 5, prior approval of the Dental Advisory Committee shall be required in the following instances:
(a) where the total fee for diagnostic services together with preventative and restorative treatment services will exceed two hundred dollars, and
(b) before effecting
(i) a full mandibular or maxillary extraction,
(ii) crowns,
(iii) complete or partial dentures,
(iv) root canal therapy,
(v) multiple extractions involving in excess of four teeth where the patient is 18 years or older, or
(vi) orthodontic services including diagnostic services and X-rays, provided that such diagnostic services and X-rays may be compensated although approval is not given for orthodontic treatment where the Committee requests the Director to do so.
84-235
6Every beneficiary or dependent who travels outside New Brunswick specifically for the purpose of receiving health services must have the prior approval of the Director for the receipt of such health services in order to receive payment therefor.
7The following persons are not beneficiaries:
(a) persons serving a term of imprisonment in a penitentiary maintained by Canada;
(b) persons serving a term of imprisonment in a goal maintained by New Brunswick or any other jurisdiction; and
(c) persons held in the New Brunswick Training School or the Nova Scotia Training School for Girls at Truro, Nova Scotia.
8A beneficiary or dependent requesting entitled services shall produce and show to the supplier of such services a valid health services card identifying the person receiving the services.
9The health services plan established by this Regulation shall be administered and operated by the Finance and Administration/Income Maintenance Division of the Department of Social Development and such other persons as are, in the opinion of the Minister, required.
87-27; 94-152; 2000, c.26, s.152; 2008, c.6, s.25
10(1)Where a person provides an entitled service to a beneficiary or dependent and desires payment from the Director therefor, that person shall submit an account for the service on the applicable form specified and supplied by the Director.
10(2)Where a beneficiary pays for an entitled service and seeks reimbursement therefor, the beneficiary shall, in order to receive payment, submit such information as the Director may require to determine the validity of the claim.
11Fees not specified in the Schedules to this Regulation with respect to entitled services shall be reasonable and just and may be so determined by the Director and authorized for payment.
12Where a person submits an account for entitled services in accordance with section 10, and is paid an amount under the health services plan, such payment is, except as provided in this Regulation, payment in full of the account and no other claim shall be made by the person supplying the service against any other person with respect to such account or any part thereof.
13(1)In this section, “assessment”, with respect to accounts submitted for payment under the health services plan, means
(a) the evaluation of such accounts,
(b) the investigation of such accounts to determine their correctness or validity, and
(c) the application and interpretation of the payment Schedules, by the Director to permit a determination as to whether payment should be made under the health services plan with respect to the accounts so submitted,
and “to assess” has a corresponding meaning.
13(2)The Director may, in his sole discretion, require any person who has submitted an account for payment under the health services plan to supply such additional information within such time as in the opinion of the Director is necessary to enable an assessment to be made under this section.
13(3)The Director may
(a) develop rules applicable to assessment under this section,
(b) assess accounts submitted for payment under the health services plan, and
(c) take such action with respect to the payment of accounts so assessed, including the making of orders
(i) denying payment of an account, or
(ii) providing that payment with respect to any entitled service for which payment is claimed in an account be made at a rate less than that provided in the payment Schedule for the entitled service,
which, in the Director’s opinion, will give effect to assessments made under this section.
13(4)No payment shall be made or authorized under the health services plan with respect to services which, in the opinion of the Director, are not entitled services under this Regulation.
14The Director may deduct, for late submission of accounts, five percent per month of each account rendered
(a) more than ninety days after the provision of the entitled service, or
(b) more than ninety days after the end of every three month period of entitled service for cases requiring services over a long period of time.
15(1)Notwithstanding section 14, no payment shall be made by the Director for entitled dental services requiring prior approval by the Dental Advisory Committee if the claim for payment is submitted beyond a period of six months after receiving approval by the Dental Advisory Committee.
15(2)If more than one account for dental services is rendered for the same patient within a six month period and the total of the accounts exceeds two hundred dollars, the Director shall not pay the accounts unless the services were approved by the Dental Advisory Committee, or are considered to be emergency services.
15(3)No payment shall be made for dental services approved by the Dental Advisory Committee until all services have been rendered including examination and radiographs.
15(4)Except where participation fees are authorized in sections 5 and 6 of Schedule II, no payment shall be made by the Director for entitled dental services where the dentist making the claim bills the patient an amount in respect of those same services.
84-235
16A person receiving services or a prosthesis for which payment is requested or has been made may be required to undergo examination by an independent examiner named by the Director and approved by the advisory committee established under section 19.
17(1)A person, being a beneficiary or a supplier of entitled services who has submitted an account for payment under the health services plan, who has any complaint concerning the assessment of accounts with respect to entitled services rendered or received, may request that the Director review or refer the matter complained of to the advisory committee established under section 19.
17(2)The time for making the request under subsection (1) shall be limited to forty days from the date the matter complained of arose, but the Director may, in his sole discretion, enlarge the time for making the request.
84-235
18The Director shall provide to the professional or trade association representing a group of suppliers any requested relevant information with respect to the payment of their accounts under this Regulation provided that
(a) the Director may charge an amount to cover the cost of supplying the information, and
(b) no information shall be communicated which would disclose an individual account or cause a violation of section 8 of the Act.
19(1)There is hereby constituted an advisory committee for dental services which shall be known as the Dental Advisory Committee and shall consist of the following:
(a) three members and an alternate appointed by the Board of the New Brunswick Dental Society each of whom shall be members in good standing of that Society, and
(b) an employee of the Department of Social Development who shall be appointed by the Minister and who shall be the Secretary.
19(2)Any three of the persons appointed under paragraph (1)(a) together with the person appointed under paragraph (1)(b) shall constitute a quorum.
19(3)The advisory committee shall advise the Minister at the Minister’s request in all matters relating to dental services and shall discharge, carry out and perform such duties to assist in all matters pertaining to an effective and efficient dental program.
19(4)Except for the member from the Department of Social Development, members shall be
(a) reimbursed such actual travelling and other necessary out-of-pocket expenses as may be approved, and
(b) remunerated for attendance at meetings at the rate of ninety dollars per half day which time shall include travelling time.
84-235; 87-27; 94-152; 2000, c.26, s.152; 2008, c.6, s.25
20Regulation 71-123 under the Health Services Act is repealed.
SCHEDULE I
The following are not entitled services under Health Services:
DENTAL SERVICES
1Orthodontic services, except treatment performed by an orthodontist.
2Self-curing relines to dentures.
3Goods or services for cosmetic purposes.
VISION SERVICES
4Contact lenses.
5Major or minor eye examinations by an optometrist
(a) for persons who are less than nineteen years of age unless such examinations have been approved by the Director, and
(b) that are more frequent than once in twenty-four months for persons who are nineteen years of age or older unless such examinations have been approved by the Director.
87-27
NURSING SERVICES
6Private duty nursing.
7Nursing service other than that provided in the patient’s home by the Victorian Order of Nurses or provided by the Red Cross nursing service.
PHARMACEUTICAL SERVICES
Repealed: 92-40
8Repealed: 92-40
85-115; 92-40
9Repealed: 92-40
89-18; 92-40
10Repealed: 92-40
89-162; 92-40
11Repealed: 92-40
85-115; 87-27; 89-18; 89-162; 92-40
SCHEDULE II
The rates of payment for entitled services are as follows:
Dental Services
1
DIAGNOSTIC SERVICES
Fee on or
after
May 1, 1989
 
01200
Oral examination
$13.00
 
01200
Recall oral examination
$13.00
 
A fee for an oral examination will be paid once within a period of twelve consecutive months. A fee for a recall oral examination may be paid once within a period of six consecutive months for children in the care of the Minister under the Family Services Act and social assistance dependent children who have not reached their fourteenth birthday.  
 
01300
Emergency examination
$13.00
 
02111
First film
$10.20
 
02112
Each additional film (regardless of type)
 
$  3.80
 
Radiographs are required for all services listed in Article 5.02 or when requested by the Dental Advisory Committee.
 
Only radiographs of proper angulation and exposure will be covered under the Agreement.
 
Diagnostic films for a beneficiary are limited to four unless additional films are requested by the Dental Advisory Committee.
 
02600
Panorex
$28.50
 
The above rate of payment for Panorex shall be paid when the x-rays are
 
(a)submitted by an oral surgeon or orthodontist,
 
(b)requested by the Dental Advisory Committee, or
 
(c)required for prior approval of the Dental Advisory Committee for multiple extractions.
 
Where a Panorex x-ray is submitted in cases other than those enumerated above, the rate of payment on or after May 1, 1989 is $17.70.
 
Panorex x-rays are not accepted for evaluation of restorative work.
85-61; 86-77; 87-138; 88-219; 89-182
 
2
SURGICAL SERVICES
Fee on or
after
May 1, 1989
Removal of erupted teeth - uncomplicated
 
71101
Single tooth - initial extraction (bone contouring or treatment of post-surgical complications included)
$  25.10
 
71111
Each additional tooth - same quadrant
$  12.00
 
72100
Impactions - I.C. Maximum
$113.30
 
72210
Impactions - I.C. Maximum
$113.30
 
72220
Impactions - I.C. Maximum
$118.40
 
72230
Impactions - I.C. Maximum
$118.40
 
The maximum fee on or after May 1, 1989 for full mouth surgical removal of teeth (twenty-two or more teeth) including alveoloplasty in any one case shall not exceed $186.00. Prior approval by the Dental Advisory Committee is required for
 
(a)all complicated extractions under 72100, 72210, 72220 or 72230, or
 
(b)multiple extractions (four or more teeth) for persons who are eighteen years of age or older. The fee for services performed by oral surgeons shall be negotiated between the oral surgeon and the Department of Social Development.  
 
73133  
Excision of torus palatinus  
$164.00  
 
73134  
Excision of torus mandibularis (unilateral)  
$  90.00  
 
73135  
Excision of torus mandibularis (bilateral)  
$145.00  
 
Fees for excisions under 73133, 73134 and 73135 shall be paid only if  
 
(a)the excision is a necessary prerequisite for a denture, and  
 
(b)prior approval of the Dental Advisory Committee is obtained.  
 
79306  
Closure of oro-antral fistula (oral surgeon only) - I.C.  
 
The fees on or after May 1, 1989 shall be a minimum of $66.00 and a maximum of $112.00.  
 
79600  
Post surgical treatment - I.C. Maximum  
$103.00  
 
Approval of the fee by the Dental Advisory Committee is required for post surgical treatment. Payment shall be made only when this treatment is done by other than the treating dentist.  
 
 
 
 
 
 
 
 
79999  
Emergency treatment of accidental trauma to the mouth for persons under eighteen years of age. The request for payment shall be accompanied by an explanation of the circumstances of the accident and a description of the details of treatment.
I.C.  
85-61; 86-77; 87-138; 88-219; 89-182; 94-152; 2000, c.26, s.152; 2008, c.6, s.25
 
3
RESTORATIVE SERVICES
Fee on or
after
May 1, 1989
Amalgam Restorations
 
(a)Primary teeth
 
21101
Amalgam, one surface
$23.50
 
21102
Amalgam, two surfaces
$31.50
 
21103
Amalgam, three surfaces or more
$39.50
 
(b)Permanent bicuspid teeth
 
21211
Amalgam, one surface
$24.00
 
21212
Amalgam, two surfaces
$39.50
 
21213
Amalgam, three surfaces or more
$47.50
 
(c)Permanent molar teeth
 
21221
Amalgam, one surface
$32.50
 
21222
Amalgam, two surfaces
$45.50
 
21223
Amalgam, three surfaces or more
$56.50
 
(d)Retentive pins
 
21301
Retentive pin, additional, one pin - per restoration
$  8.80
 
21302
Retentive pin, additional, two pins - per restoration
$19.00
 
(e)Composite restorations
 
23101
Class I and V
$30.50
 
23102
Class III
$30.50
 
23103
Class IV
$51.00
 
The maximum per tooth allowance for composite restoration on or after May 1, 1989 will ordinarily be $51.40 except in the case of two Class III restorations where the maximum per tooth allowance on or after May 1, 1989 will be $55.80.
 
(f)Acid etched composite restorations
 
23111
Class I and V
$41.00
 
23112
Class III
$50.00
 
23113
Class IV
$79.80
 
23114
Double Class IV
$93.30
 
The maximum per tooth allowance on or after May 1, 1989 for two Class III acid etched restorations is $84.50.
 
Acid etch on deciduous teeth is not an entitled service.
 
Acid etch Class V is an entitled service on permanent anteriors and buccal surfaces of maxillary bicuspids only.
 
The maximum per tooth allowance on or after May 1, 1989 for more than one Class IV restoration is $93.30. This fee includes retentive pins if applicable.
 
Acid etch Class I is an entitled service on anterior permanent teeth only.
 
If a restoration is redone by the same dentist within a period of six months, the second restoration is not an entitled service.
 
Restoration on tooth number 51, 52, 61, 62, 71, 72, 81 or 82 is not an entitled service.
 
(g)Crowns
 
Prior approval from the Dental Advisory Committee is required in all cases.
 
22220
Preformed stainless steel - Primary posterior tooth - per tooth
$68.00
 
Payment for preformed stainless steel primary posterior tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age.
 
22310
Preformed stainless steel - Permanent anterior tooth
I.C.
 
22320
Preformed stainless steel - Permanent posterior tooth
$68.00
 
22410
Prefabricated restoration on primary cuspid anterior tooth number 53, 63, 73, or 83
$68.00
 
22510
Acrylic or plastic transitional, direct (prefabricated)
I.C.
 
Fees for filling include any necessary pulp protection.
 
When at the same sitting, in order to conserve tooth structure, two separate restorations are performed on the same tooth involving a common surface, the fee will be assessed as one restoration.
 
The dental practitioner must include the proper procedure code, international tooth code and the names of the surfaces restored in order to obtain payment for a restoration.
85-61; 86-77; 87-138; 88-219; 89-182
 
 
 
4
PREVENTIVE SERVICES
Fee on or
after
May 1, 1989
Dental prophylaxis
 
11100
Primary dentition
$18.20  
 
11200
Mixed dentition
$22.00  
 
11300
Permanent dentition
$35.00  
 
Dental prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one prophylaxis within a period of twelve consecutive months. Dental prophylaxis will be considered for persons eighteen years of age and over only in cases where minor scaling is necessary in order to fabricate a partial denture.  
 
Fluoride treatment
 
12400
Fluoride topical application
$11.30  
 
Topical application of fluoride gel or liquid subsequent to prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one topical application within a period of twelve consecutive months.
85-61; 86-77; 87-138; 88-219; 89-182
5
PROSTHETIC
SERVICES
Gross fee
on or after
May 1, 1989
75%
 
Prior approval by the Dental Advisory Committee is required for complete or partial dentures.
 
Complete dentures  
 
51100
Complete
maxillary
denture  
$268.80 + Lab
$201.60 + Lab
 
51110
Complete
mandibular
denture  
$268.80 + Lab
$201.60 + Lab
 
These services include breakdown of T factor applicable, impressions, registrations, selection of shade and mold, try-in, insertion and adjustments.  
 
Removable partial dentures  
 
52120
Maxillary,
acrylic base -
no clasps  
$109.60 + Lab  
$82.20 + Lab  
 
52121  
Mandibular, acrylic
base - no clasps  
$109.60 + Lab
$82.20 + Lab
 
52220
Maxillary, acrylic
base - with
wrought clasps  
$159.70 + Lab  
$119.80 + Lab  
 
52221  
Mandibular, acrylic
base - with
wrought clasps  
$159.70 + Lab  
$119.80 + Lab  
 
These services include breakdown of T factors applicable, diagnostic models, analysis and design, tooth preparation and master impression, bite registration, mold, selection and shade, try-in, insertion and adjustments.  
 
For children who are in the care of the Minister under the Family Services Act and social assistance dependent children payment will be made at the gross amount.  
 
For adult beneficiaries and adult dependents payment will be made at 75%. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees. The participation fee applies only to the dentist fee.  
 
The total laboratory fee for upper and lower vitallium partial dentures is payable if prior approval is obtained from the Dental Advisory Committee.  
 
Fees for dentures or partial dentures are not ordinarily payable more frequently than once in five years unless prior approval is obtained from the Dental Advisory Committee.  
 
For partial dentures the dental practitioner must state what teeth are missing as partial dentures will be approved only if  
 
(a)at least one anterior tooth is missing, or  
 
(b)more than two posterior teeth are missing in one quadrant.
85-61; 86-77; 87-138; 88-219; 89-182
 
6
DENTURE REPAIRS
Gross Fee
on or after
May 1, 1989
75%
Repair of Complete Dentures
 
55101  
Maxillary, no
impression required  
$23.60 + Lab  
$17.70 + Lab  
 
55201  
Maxillary, impression
required  
$34.90 + Lab  
$26.20 + Lab  
 
55102  
Mandibular, no
impression required  
$23.60 + Lab  
$17.70 + Lab  
 
55202  
Mandibular, impression
required  
$34.90 + Lab  
$26.20 + Lab  
 
Repair of partial dentures (acrylic or vitallium only)  
 
55103  
Maxillary, no
impression required  
$26.30 + Lab  
$19.70 + Lab  
 
55203  
Maxillary, impression
required  
$36.30 + Lab  
$27.20 + Lab  
 
55104  
Mandibular, no
impression required  
$26.30 + Lab  
$19.70 + Lab  
 
55204  
Mandibular, impression
required  
$36.30 + Lab  
$ 27.20 + Lab  
 
55535  
Addition or replacement
of a clasp with a
new clasp  
$32.00 + Lab  
$24.00 + Lab  
 
55539  
Each additional clasp  
$30.70 + Lab  
$23.00 + Lab  
 
Denture (complete or partial) relining or rebasing  
 
56200  
Relining maxillary,
complete denture -
no lab required  
$44.70  
$33.50  
 
56201  
Relining mandibular,
complete denture -
no lab required  
$44.70  
$33.50  
 
56220  
Maxillary, complete -
processed  
$82.90 + Lab  
$62.20 + Lab  
 
56221  
Mandibular, complete -
processed  
$82.90 + Lab  
$62.20 + Lab  
 
56270  
Maxillary, soft tissue
conditioning  
$44.70  
$33.50  
 
56271  
Mandibular, soft tissue
conditioning  
$44.70  
$33.50  
 
Fees for complete or partial relining or rebasing or for tissue conditioning are not payable more frequently than once in each year.  
 
No prior approval of the Dental Advisory Committee is required for entitled denture repairs.  
 
For children in the care of the Minister under the Family Services Act and social assistance dependent children payment will be made at the gross amount for denture repairs including any laboratory fee.  
 
For adult beneficiaries and adult dependents payment will be made at 75% for denture repairs. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees.
84-235; 85-61; 86-77; 87-138; 88-219; 89-182  
7
ADDITIONAL SERVICES
Fee on or
after
May 1, 1989
 
92310
Conscious sedation (paedodontist only), per unit
 
Fees for conscious sedation are not payable more often than eight units per patient per year and require referral by another dentist.
 
$ 30.00
 
94100
Professional visit (at institution other than a hospital facility)
 
A fee for a professional visit will be paid up to four times per patient per treatment plan.

 
$ 22.00
 
94200
Hospital call
$ 24.00
 
94400
Special office visit after normal hours
$ 32.00
86-77; 87-138; 88-219; 89-182; 93-26
 
8(1)
ENDODONTIC SERVICES
 
31100
Pulp capping - traumatic exposure
$ 11.80
 
32200
Vital pulpotomy - permanent tooth
$ 40.00
 
32210
Vital pulpotomy - Primary posterior tooth - per tooth
 
Payment for vital pulpotomy on primary tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age.
 
Root canal therapy
 
$ 27.00
 
33100
One canal, fully developed root (on anterior teeth only)
$196.00
 
Prior approval by the Dental Advisory Committee is required.
 
The fee for a root canal includes all x-rays and closing the access canal.
 
Emergency procedures
 
39902
Emergency pulpectomy (trephination through crown included - primary and permanent tooth)  
$  28.50
 
39910
Trephination through crown into root canal without pulpectomy  
$  17.50
 
39930
Sedative (palliative) dressing (temporary filling only)  
$  22.00
 
8(2)
PERIODONTAL SERVICE
 
41200
Emergency service - acute necrotizing ulcerative gingivitis (per unit of time) (A fee for emergency service will be paid for up to two units per service date.)  
$  21.00
 
8(3)
ORTHODONTIC SERVICES
 
01900
Exam by orthodontist
$  28.30
 
02600
Panorex X-ray
$  28.50
 
04530
Model
$  34.50
 
 
 
80000
Treatment by orthodontist
I.C.
 
The orthodontist will submit to the Dental Advisory Committee a proposed treatment plan, including an estimate of the cost of treatment, models and a panorex x-ray, if desired. The plan will be reviewed by the Dental Advisory Committee. The orthodontist will be notified of the committee’s decision and will receive payment for the entitled services rendered in preparing the plan, regardless of the decision made.
86-77; 87-138; 88-219; 89-182
PHARMACEUTICAL SERVICES
87-27; 92-40
9(1)A beneficiary or dependent is eligible to receive as entitled services
(a) drugs for which prescriptions are required by law, and
(b) other drugs and services
that form part of the New Brunswick Therapeutic Drug Formulary and Interchangeable Products List.
9(2)Notwithstanding subsection (1), only a beneficiary and a dependent child under the age of 18 years who is not self-supporting are eligible to receive the following:
(a) single entity vitamins;
(b) fluoride preparations;
(c) anti-parasitic applications;
(d) antifungal agents; and
(e) allergy sera.
85-115; 92-40
10Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a pharmacy shall be that set out in section 16 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11 which may be collected from the person.
84-235; 92-40
11(1)The participation fee for each entitled service under section 9 is
 
(a)for a social assistance adult beneficiary or dependent (person 18 years of age or older)..............
$4.00
 
(b)for a social assistance child dependent (persons who have not reached their 18th birthday)..............
$2.00
11(2)Notwithstanding subsection (1), a pharmacy or dispensing physician who dispenses an entitled service under section 9 may collect an additional participation fee from a social assistance adult beneficiary or dependent as permitted under section 12.1.
11(3)No beneficiary is required to pay more than a total of two hundred and fifty dollars in participation fees under subsection (1) in respect of the beneficiary and his or her dependants in any fiscal year.
11(4)For the purposes of subsection (3), “fiscal year” means the period commencing the first day in April in any year to the thirty-first day of March in the next year, inclusive.
92-40; 96-23
12Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a dispensing physician shall be that set out in section 22 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11, which may be collected from the person.
92-40
12.1(1)Subject to subsection (2), sections 16.1, 20.1, 20.2, 20.3 and 22.1 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act apply with the necessary modifications in respect of an entitled service referred to in section 9.
12.1(2)A reference to an authorized charge in sections 20.1, 20.2 and 20.3 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act shall be deemed to be a reference to a participation fee.
92-40
13(1)Repealed: 92-40
13(2)Repealed: 92-40
13(3)For prescriptions filled by provincial regional health authority pharmacies and provincial mental health clinics payment will be made at cost plus an administrative fee to be determined by the Director.
85-124; 92-40; 93-26; 2002-32
14VISION SERVICES
87-27
14(1)Vision services - optometrist
(a)Diagnostic services
Gross Fee
on or after
October 13, 1990
 
00001
Major examination
$34.80
  
00002
Minor examination
$16.90
 
00003
Tonometry
$  7.80
 
00005
Biomicroscopy
$  7.80
 
00006
Visual Fields
$  7.90
For a major examination supplied to beneficiaries who are nineteen years of age or older and who are children in the care of the Minister under the Family Services Act, payment will be made at the gross amount and for other beneficiaries and dependents payment will be made at the gross amount less the applicable participation fee which the optometrist may collect from the patient. No participation fee is required for minor examinations, tonometry, biomicroscopy or visual fields.
Where more than one special diagnostic procedure other than a major examination is performed during the course of a follow-up visit, a minor examination fee is payable instead of the individual procedures.
Notwithstanding section 5 of Schedule I, where, on and after September 1, 1986, a person referred to in paragraph 5(b) of that Schedule has a second major examination by another optometrist within the twenty-four month period referred to in that paragraph without receiving the approval of the Director, the second major examination is an entitled service and shall be paid for at the rate prescribed in this Schedule for a minor examination.
(b)Dispensing Services
(select, measure, order,
receive, verify, fit)
Gross fee
on or after
October 13, 1990
 
(i)Initial
 
00081
Lenses pair, single vision
$18.30
 
00082
Lenses pair, bifocal
$23.20
 
00090
Frame (new)
$19.50
 
00091
Frame (old)
$  8.40
 
(ii)Replacement
 
00101
One lens, single vision
$  8.40
 
00102
One lens, bifocal
$10.50
 
00103
Frame, complete
$12.70
 
00104
Frame, front
$  5.30
 
00105
Frame, temple
$  5.30
 
(iii)Miscellaneous
 
00106
Miscellaneous repairs, alignment or adjustment (when not included in above fees)
$  4.20
Payment of an allowance toward materials specified in paragraph 15(a) shall be made directly to the optometrist who supplies them.
Fees for frame dispensing services shall not be paid where the recipient chooses a complete frame that has a wholesale cost greater than the maximum allowance for a complete frame specified in paragraph 15(a).
For eligible dispensing services supplied to children in the care of the Minister under the Family Services Act payment will be made at the gross amount.
For other beneficiaries and dependents payment will be made at the gross amount less the applicable participation fee which the optometrist may collect from the patient. Only one participation fee may be charged for the total lens and frame dispensing services.
Dispensing fees for new frames are not available unless the optometrist has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum allowance for a complete frame specified in paragraph 15(a).
14(2)Vision services - Optician
Fitting Fees (select, measure, order, receive,
verify, fit - initial, replacement or repair)
Gross Fee
 
00010
lens and frame, single vision
$18.00
 
00011
lens and frame, bifocal
$20.00
 
00012
lens only, single vision (each lens)
$  4.00
 
00013
lens only, bifocal (each lens)
$  6.00
 
00014
frame, complete
$  4.25
 
00015
frame, temple only
$  1.25
 
00016
frame, front only
$  3.25
 
00017
miscellaneous repairs, alignment or
adjustment
$  1.10
Fees for frame dispensing services will not be paid in cases where the recipient chooses a frame that has a wholesale cost greater than the maximum frame allowance specified in paragraph 15(b).
Dispensing fees for new frames are not available unless the optician has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum frame allowance specified in paragraph 15(b).
14(3)The participation fee for each vision service is
(a)for beneficiaries and dependents who are nineteen years of age or older
$  4.00
 
(b)for beneficiaries and dependents who are less than nineteen years of age
$  1.00
 
(c)for children in the care of the Minister under the Family Services Act, no participation fee is required.
84-235; 85-61; 85-90; 87-27; 88-220; 89-138; 92-41
15MATERIALS
(a)Optometrists
Maximum Allowance on and after October 13, 1990
 
00041
frame - complete:
 
(i)for children in care of the Minister under the Family Services Act - maximum allowance
$34.00
 
(ii)for social assistance beneficiaries and dependents - maximum allowance
$17.00
 
00042
     case
$  1.05
 
00043
     frame - front only
 
 
 
 
(i)for children in care of the Minister under the Family Services Act and dependents who are less than nineteen years of age - maximum allowance
$18.60
 
(ii)for beneficiaries and dependents who are nineteen years of age and older - maximum allowance
$  9.30
 
00044
     frame - both temples
 
(i)for children in the care of the Minister under the Family Services Act and dependents who are less than nineteen years of age - maximum allowance
$12.40
 
(ii)for beneficiaries and dependents who are nineteen years of age and older - maximum allowance
$  6.20
 
00045
     frame - one temple
 
(i)for children in the care of the Minister under the Family Services Act and dependents who are less than nineteen years of age - maximum allowance
$  6.20
 
(ii)for beneficiaries and dependents who are nineteen years of age and older - maximum allowance
$ 3.10
 
00047
replacement frame
$15.80
 
(b)     Opticians
 
00020
     lenses
Wholesale Price
 
00021
     frame - complete
 
(i)for children in care of the Minister under the Family Services Act - maximum allowance
$20.00
 
(ii)for social assistance beneficiaries and dependents on and after July 29, 1991
$17.00
 
00022
     frame - front only
 
(i)for children in care of the Minister under the Family Services Act and other beneficiaries and dependents who are less than nineteen years of age - maximum allowance
$  5.50
 
(ii)for beneficiaries and dependents who are nineteen years of age or older - maximum allowance
$  1.50
 
00023
     frame - both temples
 
(i)for children in care of the Minister under the Family Services Act and other beneficiaries and dependents who are less than nineteen years of age - maximum allowance
$  3.00
 
(ii)for beneficiaries and dependents who are nineteen years of age - maximum allowance
$  1.50
 
00024
frame- one temple
 
(i)for children in care of the Minister under the Family Services Act and other beneficiaries and dependents who are less than nineteen years of age - maximum allowance
$  2.00
 
(ii)for beneficiaries and dependents who are nineteen years of age and older - maximum allowance
$  1.00
 
00025
 case
$  1.00
 
00027
Replacement frame, on and after July 29, 1991
$15.80
84-235; 85-61; 87-27; 89-138; 92-41; 92-42
16ARTIFICIAL EYES - wholesaler charges plus a five dollar service fee.
17DENTURIST SERVICES
Prior approval by the Director is required for a complete maxillary or mandibular denture provided by a denturist.
(a) Complete Dentures
Gross Fee on or after January 1, 1989
75%
 
Complete maxillary or mandibular denture
$257.00
$192.75
These services include examination and consultation, preliminary and final impressions, bite registration, acrylic denture, selection of teeth (bioblend or equivalent), try-in, insertion adjustments and laboratory charges.
For children in the care of the Minister under the Family Services Act and social assistance dependents under the age of eighteen, payment will be made at the gross amount.
For adult beneficiaries and social assistance dependents eighteen years of age and older, payment will be made at seventy-five per cent. The denturist may collect the balance from the patient.
Fees for complete maxillary or mandibular dentures are not ordinarily payable more frequently than once in five years unless prior approval is obtained from the Director.
(b) Denture Relining, Rebasing or Repairs
Gross Fee on or after January 1, 1989
75%
 
Complete maxillary or mandibular, denture - reline
$66.00
$49.50
 
Complete maxillary or mandibular, denture - rebase
$76.00
$57.00
 
Complete maxillary or mandibular tissue conditioning
$20.00
$15.00
 
Complete maxillary or mandibular, denture - repairs (no impression required)
$19.65
$14.75
 
Complete maxillary or mandibular, denture - repairs (impression required)
$38.00
$28.50
 
Replacement of lost or fractured tooth
$18.90
$14.20
 
Minor adjustments - after three months
$  9.50
$  7.10
 
House, nursing home or hospital call - (maximum of four per case per year)
$12.00
$12.00
No prior approval is required for entitled denture relining, rebasing or repairs.
For children in the care of the Minister under the Family Services Act and social assistance dependents under the age of eighteen, payment will be made at the gross amount.
For adult beneficiaries and social assistance dependents eighteen years of age and older, payment will be made at seventy-five per cent. The denturist may collect the balance from the patient.
85-61; 89-139
N.B. This Regulation is consolidated to July 1, 2008.