Chronic disease management MBS items for AHPs

Chronic disease management (CDM) Medicare items are used by health professionals who are managing the health care of patients with a chronic medical condition. It is often challenging for AHPs to work out when and which MBS item to claim. We have therefore provided a summary below to give some guidance.

Patients who have a chronic or terminal condition and who would benefit from a structured care approach are eligible for a General Practice Management Plan (GPMP). Conditions where complex care patients require ongoing care from a multidisciplinary team comprising their GP and at least two other health care providers are eligible for Team Care Arrangements (TCA).

Once a GPMP and TCA have been prepared, the patient may be eligible to access certain individual allied health services directly related to the management of chronic diseases or conditions on referral.

A Medicare rebate is available for a maximum of five individual services per patient each calendar year once a GPMP (item 721) and TCA (item 723) are in place. Patients must be presented with a copy of the GPMP and TCA, and a copy added to the patient's medical records.

Public in-patients of a hospital and Australian Government-funded residents of an aged care facility are ineligible for a GPMP and TCA.

Information regarding Medicare follow up allied health services for people of Aboriginal and Torres Strait Islander descent is available from the external link Department of Health

More information about Medicare items for individual allied health services for people with chronic conditions and complex care needs is available from the external link Department of Health

More information about CDM items and explanatory notes are available at external link MBS Online