NHS-funded orthodontic treatment is only available to patients with a definite clinical need for treatment who are under 18 years of age.
A patient would have to be assessed to determine eligibility for NHS-funded orthodontic treatment. This is done using the Index of Orthodontic Treatment Needed (IOTN).
NHS orthodontic treatment is not usually available for patients over 18 years old, but may be approved by local NHS Commissioners, on a case-by-case basis if the functional needs are great.
Practices in England
From 1 April 2019, if a patient is 18 years or over on the date of referral, you’ll need approval from the Commissioner before a patient starts orthodontic treatment.
When you submit the FP17O, the ‘Commissioner Approval’ box must be completed. If the Commissioner Approval box is not completed and the patient is 18 or over, the claim will be rejected.
The Commissioner will need to use the override function in compass to allow the claim to go through without a patient charge.
Practices in Wales and treatment with a Date of Assessment before 1 April 2019 in England
If a Commissioner approves a claim outside of normal processing rules, such as starting orthodontic treatment when a patient is aged 18 or over, they can use the ‘Override Rule Update’ function in Compass.
This option is available in the ‘Activity’ folder on the Compass Homepage menu.
Once the rule is added to Compass, the practice can submit the claim for processing.
If the claim is already processed, the Commissioner can email us to override the claim (to make sure that a patient charge is not levied) at dental.charges@nhsbsa.nhs.uk