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Download Orthodontic Index of Treatment Need (IOTN)
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Orthodontic Index of Treatment Need (IOTN) Is treatment for one or more of the following treatments only item(s) 32(a)(1), 32(b) or 32(c)? Yes NO IOTN Grade needed No What is the IOTN Grade for this patient? IOTN Grade 1 IOTN Grade 2 IOTN Grade 3 IOTN Grade 4 IOTN Grade 5 Will not be considered for orthodontic treatment under GDS, due to lack of health benefit Will, as a rule, not be considered for orthodontic treatment under GDS, due to lack of health benefit Aesthetic component (AC) must be added to the dental component (DC) to give IOTN Grade (DC/AC) Will be considered for orthodontic treatment under GDS Will be considered for orthodontic treatment under GDS No Does case have exceptional circumstances? DC/AC Grade of 3/1 to 3/5 DC/AC Grade of 3/6 to 3/10 Mark IOTN Grade at part 15 of GP17(O) Will be considered for orthodontic treatment under GDS Complete GP17(O) form and submit for Prior Approval. Study models and radiographs/ photographs are not required Yes Will, as a rule, not be considered for orthodontic treatment under GDS, due to lack of health benefit No need to submit form. Approval will not be granted. No Does case have exceptional circumstances? No PSD select for random assessment? Yes Yes Mark IOTN Grade at part 15 of GP17(O) Complete GP17(O) form and submit for Prior Approval, along with study models and radiographs/ photographs as appropriate PSD assess for Prior Approval PSD return form with Prior Approval decision PSD record details and return form granting Prior Approval PSD request you to submit study models and radiographs/ photographs PSD assess for Prior Approval PSD return form with Prior Approval decision
