Medicare Benefits Schedule - Item 10951

Diabetes education health service provided to a patient by an eligible diabetes educator if:

(a) the patient has a chronic condition and complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under:

(i) a GP chronic condition management plan that has been prepared or reviewed in the last 18 months; or

(ii) until the end of 30 June 2027—a GP Management Plan and Team Care Arrangements prepared prior to 1 July 2025; or

(iii) a multidisciplinary care plan; and

(b) the service is recommended in the patient’s plan or arrangements as part of the management of the patient’s chronic condition and complex care needs; and

(c) the service is of at least 20 minutes duration;

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth Attendance Determination applies) in a calendar year

Fee: $72.65 Benefit: 85% = $61.80

(See para AN.15.3, AN.15.5, AN.15.6, MN.3.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $217.95

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Publication date: 1 July 2025

Summary

This note provides an overview of MBS items to support the management of patients with chronic conditions in general practice by general practitioners (see GN.4.13) and prescribed medical practitioners (see AN.7.1). For detailed information on the individual items, including item requirements and patient eligibility, see item-specific notes listed below. 

MBS and management of patients with chronic conditions

There are a range of MBS items for clinically relevant services provided in general practice for patients with chronic conditions. These include: 

• time-tiered attendance items (see AN.0.9), which can be used when a more specific MBS item does not apply

• health assessment items for early detection and prevention of chronic conditions in specific patient cohorts (see AN.0.36, AN.0.43, AN.14.2 and AN.14.3)
  
  
• items to support general practitioners and prescribed medical practitioners to develop and review plans the care of patients with a chronic condition and, where relevant, refer patients to MBS-supported allied health services (see AN.0.47 for chronic condition management plans and AN.15.7 and AN.15.8 for multidisciplinary care plans)
  
  
• medication management reviews to support quality use of medicines and minimise the risk of medication misadventure (see AN.0.52 and AN.7.18)
  
  
• case conferencing items to support multidisciplinary team care (see AN.0.49).

Patients with a mental health condition or eating disorder may be eligible for treatment through the Better Access mental health items (see AN.0.56) or eating disorder items (see AN.36.2).

It is important to note that:

• some of these items have specific eligibility criteria that are detailed in the item-specific explanatory notes, and
  
  
• all MBS services must be clinically relevant, meaning they are generally accepted in the medical profession as necessary for the appropriate treatment of the patient

General practitioners and prescribed medical practitioners in primary care can also refer patients to specialists where appropriate as part of the management of their chronic condition.

GP chronic condition management plans and multidisciplinary care plans 

GP chronic condition management plans and multidisciplinary care plan items allow GPs/prescribed medical practitioners to develop and periodically review structured plans for patients with a chronic condition. 

Patient Eligibility 

These items are available to patients that have at least one medical condition that has been (or is likely to be) present for at least 6 months, or is terminal. There is no list of eligible conditions. It is up to the GP or prescribed medical practitioner’s clinical judgment to determine whether an individual patient with a chronic condition would benefit from a structured plan for the management of their condition. 

In considering the need for a structured plan, GPs and prescribed medical practitioners need to ensure the service is clinically relevant, which is a requirement of the Health Insurance Act 1973. The Act defines a clinically relevant services as “a service rendered by a medical or dental practitioner or an optometrist that is generally accepted in the medical, dental or optometric profession (as the case may be) as being necessary for the appropriate treatment of the patient to whom it is rendered.”

GP chronic condition management plans

A GP chronic condition management plan is a plan that is developed collaboratively between the general practitioner/prescribed medical practitioner and the patient for the management of the patient’s chronic condition(s). Patients registered with a practice through MyMedicare must access these services through the practice at which they are registered. Patients that are not registered can access these services from their usual medical practitioner See AN.0.47 for detailed information on GP chronic condition management plans. 

Multidisciplinary care plans

Multidisciplinary care plans allow for the general practitioner/prescribed medical practitioner to contribute to a plan which may be coordinated by another person. MBS items 232, 731, 92027 and 92058 are available for patients living in a residential aged care facility; MBS items 231, 729, 92026 and 92057 are available for patients not in residential aged care.

Patients living in residential aged care who have a multidisciplinary care plan have the same access to allied health and other services as patients with a GP chronic condition management plan.

See AN.15.7 and AN.15.8 for detailed information.

Services available under GP chronic condition management plans and multidisciplinary care plans

A range of MBS-supported multidisciplinary services may be available to patients with a GP chronic condition management plan or a multidisciplinary care plan, where those services are consistent with the plan.

Patients who had a GP management plan and/or team care arrangement prior to 1 July 2025 can continue to access the services outlined below until 30 June 2027 under those plans. For more information about the transition arrangements for GP chronic condition management plans see AN.15.5.

Services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner

Patients with a GP chronic condition management plan or a multidisciplinary care plan can access up to 5 services per calendar year provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner to support management of their chronic condition (MBS items 93201, 93203 and 10997). The services provided must be consistent with the patient’s plan. See MN.12.4 for detailed information about the use of these items.

For follow up services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for a person of Aboriginal or Torres Strait Islander descent who has received a health assessment see MN.12.3.

Individual allied health services

Patients with a GP chronic condition management plan or care recipient of an aged care facility that have a multidisciplinary care plan can access up to 5 (10 for a person of Aboriginal or Torres Strait Islander descent) individual MBS supported allied health services per calendar year. The allied services provided must be consistent with the patient’s plan and a referral is required.

For more information on the types of allied health services available see AN.15.4.

For detailed information about the allied health items see MN.3.1.

For information on referral requirements for allied health see AN.15.6.

Group allied health service for patients with type 2 diabetes

Patients with type 2 diabetes who have a GP chronic condition management plan, or are a care recipient of an aged care facility and have a multidisciplinary care plan, can be assessed for their suitability for group diabetes education, exercise physiology or dietetics services. Patients are eligible for one assessment per calendar year and, if they are found suitable, up to 8 group services per calendar year.

For detailed information on suitability assessments and group allied health services see MN.9.1 and MN.9.2.

Related Items: 231 232 245 249 392 393 729 731 900 903 965 967 10950 10951 10952 10953 10954 10955 10956 10957 10958 10959 10960 10962 10964 10966 10968 10970 10997 81100 81105 81110 81115 81120 81125 81300 81305 81310 81315 81320 81325 81330 81335 81340 81345 81350 81355 81360 92026 92027 92029 92030 92057 92058 92060 92061 93201 93203

Publication date: 1 July 2025

SUMMARY

On 1 July 2025, GP Management Plans (MBS items 229, 721, 92024 and 92055) and Team Care Arrangements (MBS items 230, 723, 92025 and 92056) were replaced with the new GP chronic condition management plan framework (MBS items 392, 965, 92029 and 92060). MBS items for reviewing a GP Management Plan or Team Care Arrangement (MBS items 233, 732, 92028 and 92059) also ceased. This note sets out the transition arrangements for patients that have a GP Management Plan and/or Team Care Arrangement that was put in place prior to 1 July 2025.

These transition arrangements are intended to allow for a smooth transition to the new framework, minimising the risk of service disruption for new and existing patients.

Patients with a multidisciplinary care plan (see AN.15.7 and AN.15.8) are only affected by the changes to referral requirements.

TRANSITION ARRANGEMENTS – PLANS

Patients with an existing GP Management Plan and/or Team Care Arrangements (ie the plans were put in place prior to 1 July 2025) can continue to access services under those plans for two years.

Patients that had a GP Management Plan and/or Team Care Arrangement in place prior to 1 July 2025 can continue to access allied health and other services that are consistent with those plans until 1 July 2027. From 1 July 2027 a GP chronic condition plan or multidisciplinary care plan will be required for ongoing access to services. 

The items for reviewing GP Management Plans and Team Care Arrangements (MBS items 233, 732, 92028 and 92059) are also ceasing. GP Management Plans and Team Care Arrangements should not be reviewed under the new GP chronic condition management review items (393, 967, 92030 and 92061). If a patient requires a review of their GP Manage Plan or Team Care Arrangement, it is an appropriate time to transition them to the new GP chronic disease management plan.

The services that can continue to be accessed by eligible patients with a GP Management Plan and/or Team Care Arrangement until 1 July 2027 are:

• MBS item 10997 (see MN.12.4) – patients with a GP Management Plan and/or Team Care Arrangement
  
  
• Group M3 individual allied health services for chronic condition management (see MN.3.1)– patients with a GP Management Plan and Team Care Arrangement
  
  
• Group M9 allied health group services (see MN.9.1 and MN.9.2) – patients with a GP Management Plan and type 2 diabetes
  
  
• Group M11 allied health services for Aboriginal and Torres Strait Islander people (see MN.11.1) – when accessed through a GP Management Plan and Team Care Arrangement
  
  
• Telehealth equivalent items (as applicable) for the above categories

My patient has a GP Management Plan and Team Care Arrangement. When do I need to move them to a GP chronic condition management plan (GPCCMP)?

They will need to have a GP chronic condition management plan in place by 1 July 2027 if they need to continue to access the services listed above on or after that date. 

The number of allied health services (5 individual services) available is counted from 1 January each year. Will my patient need a GP chronic condition management plan before they can access allied health services in the new year?

No. If the allied health services required are still consistent with the patient’s team care arrangement they do not need to transition to a GP chronic condition management plan to continue to access allied health services in the new year.

Patients will need to have transitioned to a GPCCMP to continue to access allied health services after 1 July 2027.

My patient’s condition has changed and as a result their team care arrangement needs to be reviewed to change the types of allied health services they receive. Item 732 has been removed. What should I do?

This is an appropriate time to put in place a new GP chronic condition management plan for the patient. 

Can I review my patient’s GP Management Plan and Team Care Arrangement using the new items to review a GP chronic condition management plan?

No. The new items are for reviewing a GP chronic condition management plan only. Instead of reviewing the old plans a new GP chronic condition management plan should be prepared. 

What happens if my patient doesn’t have a GP chronic condition management plan in place on 1 July 2027?

Your patient won’t be able to access MBS-supported allied health services (or item 10997 services) from 1 July 2027 until a GP chronic condition management plan is in place.

I am an allied health professional. I agreed to be part of my patient’s team care arrangement before 1 July 2025. Can I continue to provide services consistent with the team care arrangement? 

Yes. The patient can continue to access services that are consistent with their Team Care Arrangement until 1 July 2027. From 1 July 2027 they will need to have a GP chronic condition management plan to continue to access services. In all cases a valid referral is also required.

I am a diabetes educator. I assessed my patient as suitable for group diabetes education services for patients with type 2 diabetes before 1 July 2025 but they hadn’t attended any group sessions by that date. Are they still eligible to access the group services under their GP Management Plan?

Yes, if the service is consistent with their GP Management Plan patients can continue to access service under that plan until 1 July 2027. 

TRANSITION ARRANGEMENTS – REFERRALS

From 1 July 2025 all new referrals for allied health services for patients with a chronic condition should be in line with the new referral requirements (see AN.15.6). Referrals that were issued prior to this date can continue to be used until they expire.

I gave my patient a referral for physiotherapy under their GP Management Plan and Team Care Arrangement in February 2025. They still have two services remaining on that referral. Do I need to write another referral so they can continue to access the services?

No. Referrals issued before 1 July 2025 continue to be valid until all services covered by the referral have been provided.

My patient hasn’t transitioned to the new GP chronic condition management plan yet, but they need a new referral for their mental health service. Should I use the old form or issue a referral letter?

The new referral should be a letter. All referrals issued from 1 July 2025 should meet the new requirements (see AN.15.6), regardless of which plan type they are made under.

I am a speech therapist. I have a new patient and their referral was issued on the old form prior to 1 July 2025. Can I accept it?

Yes. Referrals issued prior to 1 July 2025 remain valid until all services covered by the referral have been delivered.

I am a podiatrist. My patient in a residential aged care facility has a multidisciplinary care plan that includes podiatry. What form should their new referral take?

If the referral is issued on or after 1 July 2025 the referral should be a letter and should meet the new referral requirements (see AN.15.6).

I am an occupational therapist. My patient’s referral provided for 3 occupational therapy sessions in 2025. They had used two services before 1 July 2025. Is a new referral required before I can provide the third service?

No. Referrals issued before 1 July 2025 continue to be valid until all services covered by the referral have been provided.

RECORD KEEPING AND REPORTING REQUIREMENTS

Providers are responsible for ensuring services claimed from Medicare using their provider number meet all legislative requirements and they may be required to submit evidence for compliance checks related to Medicare claims. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation at www.legislation.gov.au.  

Related Items: 392 393 965 967 10950 10951 10952 10953 10954 10955 10956 10957 10958 10959 10960 10962 10964 10966 10968 10970 10997 81100 81105 81110 81115 81120 81125 81300 81305 81310 81315 81320 81325 81330 81335 81340 81345 81350 81355 81360 92029 92030 92060 92061

Publication date: 1 July 2025

SUMMARY

This note sets out the requirements for referring patients to MBS-supported allied health services. These requirements apply to referrals written on or after 1 July 2025.

APPLICATION OF REFERRAL REQUIREMENTS

The requirements outlined in this note apply to referrals written on or after 1 July 2025 for the following groups of allied health services and, where applicable, their telehealth (video and phone) equivalents:

• M3 (subgroup 1) – individual allied health services for patients with a chronic condition (referred under the chronic conditions management arrangements (see MN.3.1)

• M8 – pregnancy support counselling allied health services (see MN.8.1)

• M9 – allied health group services for patients with type 2 diabetes (referred under the chronic conditions management arrangements (see MN.9.1 and MN.9.2)

• M10 (subgroup 1) – complex neurodevelopmental disorders and eligible disabilities allied health services (see MN.10.1)

• M11 – allied health services for Aboriginal and Torres Strait Islander people (referred under the chronic conditions management arrangements or following an Aboriginal and Torres Strait Islander health assessments (see MN.11.1))

As of 1 July 2025, these requirements do not apply to other MBS-supported allied health services, including Better Access psychological therapy services, focussed psychological strategies (allied mental health) services, eating disorder allied health services, or diagnostic audiology services.

REFERRAL REQUIREMENTS

The requirements for referrals to allied health professionals are set out in the Health Insurance (Section 3C – Allied Health Services) Determination 2024 (Allied Health Determination) and mirror those for referrals to medical specialists and other MBS-supported services. The Allied Health Determination requires the following “prescribed particulars” to be included in the referral:

• The name of the referring practitioner
  
  
• The address of the practice, or the practitioner’s provider number at that practice, of the referring practitioner
  
  
• The date on which the referring practitioner made the referral

The Allied Health Determination also requires that referrals:

• Be in writing

• Signed by the referring practitioner (noting this can be an electronic signature)

• Dated, and

• Explain the reasons for referring the patient, including any information about the patient’s condition that the referring practitioner considers necessary to give the allied health professional.

How long is a referral valid?

Referrals for allied health services for patients with chronic conditions (M3, M10 and M11) are valid for:

• The period of time stated in the referral, or
  
  
• If no timeframe is stated, 18 months.

These timeframes are measured from the date the first service is provided under the referral, not the date of the referral.

Does the referral need to specify the number of services to be provided?

No. From 1 July 2025 referrals do not need to specify the number of services to be provided. However, nothing prevents the referring medical practitioner from specifying the number of services to be provided under the referral if they choose to do so.

This recognises that some patients accessing allied health services may wish to access a higher number of services than are supported by the MBS. As the MBS benefits are the patient’s benefit, ultimately it is up to them to determine which services they would like to use their MBS benefit for.

For information on which allied health professionals are eligible to provide MBS services see AN.15.4.

Does the referral need to include the allied health professional’s name?

No. The patient can take the referral to any eligible allied health professional of the same profession/type specified in the referral of their choosing. For example, a referral to physiotherapy services can be taken to any physiotherapist, but it cannot be used to access chiropractic services.

I am an allied health professional. Can I accept a referral with another allied health professional’s name on it?

Yes. The patient can choose to take their referral to any eligible allied health professional of the same profession/type specified in the referral.

I am an allied health professional. Am I required to accept a referral?

No. Acceptance of a referral is at the discretion of the individual practitioner, subject to anti-discrimination legislation. However, if the referral is not accepted after being presented to the practice it is important to inform the referring practitioner that the request cannot be accommodated.

I am an occupational therapist and I will be away when my patient is due for their next appointment. Can another practitioner in my practice provide the service or does the patient have to delay their appointment until I return?

Yes, your patient can see another practitioner in the practice under the same referral, provided the other practitioner is an eligible allied health professional of the same profession/type specified in the referral. In this circumstance the allied health professional that provides the service would need to report to the referring medical practitioner, if required.

The referral has to be signed and in writing. Does this mean it needs to be in hard copy?

No. The Electronic Transactions Act 1999 allows for documents required under Commonwealth Law, such as referrals under the Allied Health Determination, to be signed and transmitted electronically.

Are there any differences in the requirements for referrals to allied health providers and medical specialists?

Yes, there are some differences in the requirements:

• For allied health services for patients with a chronic condition (M3, M10 and M11), the default length of an allied health referral is 18 months from the date of the first service provided under the referral. This aligns with the requirement for patients with a GP chronic condition management plan to have had their plan put in place or reviewed within the last 18 months to continue to access services (see AN.0.47). For specialist services the default referral length is 12 months from the date of the first service provided under the referral
  
  
• Referrals to allied health professionals cannot be indefinite referrals. This is in recognition of the requirement of many allied health items to provide a report back to the referring medical practitioner after the last service on the referral
  
  
• There is no emergency exception to the requirement for a written referral to exist before Allied health services are rendered unlike for specialist or consultant physical referred attendances.

What happens if the referral gets lost or destroyed?

A service can be provided on the basis of a lost, stolen or destroyed referral. However, this is not expected to be a common occurrence. In these circumstances the phrase ‘lost referral’ replaces the prescribed particulars.

Where the intended allied health provider is known, referring practitioners are encouraged to send referrals electronically whenever possible to minimise the risk of lost referrals.

RECORD KEEPING AND REPORTING REQUIREMENTS

Providers are responsible for ensuring services claimed from Medicare using their provider number meet all legislative requirements and they may be required to submit evidence for compliance checks related to Medicare claims. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document is created, the document must be retained for the period of 2 years. 

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation at www.legislation.gov.au. Referral requirements for allied health services are set out in the Health Insurance (Section 3C – Allied Health Services) Determination 2024.

Related Items: 232 392 393 731 965 967 10950 10951 10952 10953 10954 10955 10956 10957 10958 10959 10960 10962 10964 10966 10968 10970 81000 81005 81010 81100 81105 81110 81115 81120 81125 81300 81305 81310 81315 81320 81325 81330 81335 81340 81345 81350 81355 81360 82000 82005 82010 82015 82020 82025 82030 82035 92027 92029 92030 92058 92060 92061

Publication date: 1 July 2025

SUMMARY

This note sets out the requirements for the individual allied health services for patients with a chronic condition. These services are part of the MBS framework for patient with a chronic condition (see AN.15.3).

Individual allied health services are available to  patients with a GP chronic condition management plan (see AN.15.4) or residents of a residential aged care facility that have a multidisciplinary care plan (see AN.15.8). Until 1 July 2027 these services are also available to patients that have both a GP management plan and team care arrangement (see AN.15.5).

The allied health services must be consistent with the patient’s plan and a GP or prescribed medical practitioner must refer the patient for the service (see AN.15.6).

Patients can access up to 5 MBS-supported individual allied health services each calendar year (January to December).

On 1 July 2025 GP management plans and team care arrangements were replaced with new GP chronic condition management plan (see AN.15.3) items. These new items provide a streamlined and simplified approach to multidisciplinary care for patients with a chronic condition. Transition arrangements are in place for existing patients with a GP management plan and team care arrangement (see AN.15.5). New requirements for referrals to allied health services written on or after 1 July 2025 also came into effect (see AN.15.6).

References in this note to the term “Management Plan” refer to any of a GP chronic condition management plan, GP management plan and team care arrangement, or a multidisciplinary care plan for a resident of a residential aged care facility.

USE OF THE ITEMS

Individual allied health services items are for the provision of allied health services that are consistent with the patient’s Management Plan to support the management of their chronic condition.

The requirements of the items for individual allied health services are set out in the Health Insurance (Section 3C General Medical Services - Allied Health Services) Determination 2024 (Allied Health Determination) and the Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 (Telehealth Determination).

Is there a minimum length for the service?

Yes, the Allied Health and Telehealth Determinations specify that the service must last at least 20 minutes.

The service I provide must be consistent with the Management Plan. How do I know what is in the Management Plan?

Subject to the patient’s consent, you will be given the relevant parts of the Management Plan. In addition, you will receive a referral from the treating medical practitioner (see AN.15.6).

How long does a referral last?

For referrals written on or after 1 July 2025, referrals will be valid for the length of time specified in the referral, or if no timeframe is specified, 18 months from the date of the first service provided under the referral. The referral may also specify the number of services to be provided, however, this is not required.

For referrals written prior to 1 July 2025 the referral must specify the number of services. The referral remains valid until all services are provided.

For further information on referrals see (AN.15.6).

Should the referral be for a named specific allied health professional?

No. The patient can take the referral to any eligible allied health professional of the same profession/type specified in the referral of their choosing. For example, a referral to physiotherapy services can be taken to any physiotherapist, but it cannot be used to access chiropractic services.

For further information on referrals see (AN.15.6).

How many individual allied health services can be claimed for a patient?

Patients can access up to 5 MBS-supported individual allied services per calendar year (January to December). The 5 services can be made up of one type of service (e.g. 5 physiotherapy services) or a combination of different types of services (e.g. 1 dietetic and 4 podiatry services).

Aboriginal or Torres Strait Islander patients can claim additional allied health services under MBS Group M11 (see MN.11.1).

My patient’s Management Plan identifies more than 5 individual allied health services. Which ones should be billed to the MBS?

The MBS benefit is the patient’s benefit. Ultimately it is up to the patient to decide how they use their MBS benefits. Some patients can access additional services using private health insurance extras cover, non-MBS services (e.g. through state or PHN programs), or self-funding.

Providers should obtain informed financial consent from patients for the service. Therefore, it is important that you clarify with the patient whether they would like to use their MBS-benefit for the service.

Can the patient claim for a service under Medicare and private health insurance?

No. Patients cannot claim MBS benefits and payments under their private health insurance fund for the same service.

How do I know how many individual allied health services a patient has already used this year?

You can check a patient’s eligibility for a service through the MBS Items Online Checker Check MBS Item numbers - Health professionals - Services Australia and view their care plan history through HPOS Patient details in HPOS - Health professionals - Services Australia. Patients can also check their care plan service history through their Medicare Online Account.

My patient has elected not to claim MBS benefits for the service. Do I still need to meet all of the requirements of the MBS item?

No. However, it is still good practice to provide regular updates to the patient’s GP about their progress.

Am I required to provide information back to the referring medical practitioner?

Yes. The Allied Health Determination requires that the allied health professional provide a written report to the referring medical practitioner:

"i. if the service is the only service under the referral—in relation to that service; or

ii. if the service is the first or last service under the referral—in relation to that service; or

iii. if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters.”

What should I include in a report back to the referring medical practitioner?

Generally, written reports should include:

• any investigations, tests, and/or assessments carried out on the patient;
  
  
• any treatment provided; and
  
  
• advice regarding future management of the patient's condition or problem.

ELIGIBLE PATIENTS

Patients are eligible for an individual allied health service if:

• they have a:
  
  
  • GP chronic condition management plan that has been put in place or reviewed in the last 18 months, or
    
    
  • Until 1 November 2026, a GP management plan and team care arrangement that were in place before 1 November 2024, or
    
    
  • Are a resident of a residential aged care facility and have a multidisciplinary care plan
    
    
• the service provided is consistent with the Management Plan, and
  
  
• they have a referral from their GP or prescribed medical practitioner for the service.

ELIGIBLE PRACTITIONERS

Allied health professionals are eligible to provide these services if they meet the qualification and credentialling requirements set out in the Allied health Determination (see AN.15.4). To provide MBS services eligible health professionals must have a Medicare Provider Number.

There are MBS item numbers for each allied health service for face to face services. However, all service types are provided using the same items for video (93000), or phone (93013) services. The treating allied health professional must satisfy themselves that a service is appropriate to be delivered by video or telephone. The limit of 5 services per year for the patient applies across all modes of service.

Service	Eligible allied health professionals (must meet any relevant credentialling requirements)	MBS item number (face to face service)
Aboriginal and Torres Strait Islander health service	Aboriginal Health Worker	10950
Audiology health service	Audiologist	10952
Chiropractic health service	Chiropractor	10964
Diabetes education health service	Credentialled diabetes educator	10951
Dietetics health service	Accredited practising dietitian	10954
Exercise physiology health service	Accredited exercise physiologist	10953
Mental health service	Aboriginal health worker Aboriginal and Torres Strait Islander health practitioner Credentialled mental health nurse Occupational therapist Psychologist (general registration) Social worker	10956
Occupational therapy health service	Occupational therapist	10958
Osteopathy health service	Osteopath	10966
Physiotherapy health service	Physiotherapist	10960
Podiatry health service	Podiatrist	10962
Psychology health service	Psychologist (general registration)	10968
Speech pathology health service	Certified practising speech pathologist	10970

RECORD KEEPING AND REPORTING REQUIREMENTS

The Allied Health Determination requires that the allied health professional provide a written report to the referring medical practitioner:

"i. if the service is the only service under the referral—in relation to that service; or

ii. if the service is the first or last service under the referral—in relation to that service; or

iii. if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters.”

It is a requirement that, where an item specifies the creation of a document (however described) and a document it created, the document must be retained for a period of 2 years. This includes records made by the allied health provider for reporting back to the referring medical practitioner.

Providers are responsible for ensuring services claimed from Medicare using their provider number meet all legislative requirements and they may be required to submit evidence for compliance checks related to Medicare claims. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item can be found on the Federal Register of Legislation at www.legislation.gov.au. Individual allied health items are set out in two regulatory instruments:

• Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024 – items 10950, 10952, 10964, 10951, 10954, 10953, 10956, 10958, 10966, 10960, 10962, 10968 and 10970
  
  
• Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 - items 93000 and 93013

Related Items: 10950 10951 10952 10953 10954 10956 10958 10960 10962 10964 10966 10968 10970 93000 93013