Medicare Benefits Schedule - Item 10997

 

Service provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic condition, if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person is not an admitted patient of a hospital; and

(c) the person has in place:

(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, or team care arrangements, prepared before 1 July 2025; or

(iii) a multidisciplinary care plan; and

(d) the service is consistent with the plan or arrangements

Applicable up to a total of 5 services to which this item, item 92301 or item 93203 applies in a calendar year

Fee: $14.00 Benefit: 100% = $14.00

(See para AN.15.3, AN.15.5, MN.12.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $42.00

• Previous - Item 10992
• Next - Item 11000

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 outlines the requirement for items 93201 (video), 93203 (telephone), and 10997 (face to face) for the provision of services for the management of a patient’s chronic condition. The service is provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner and must be consistent with the patient’s GP chronic condition management plan (see AN.0.47), multidisciplinary care plan (see AN.15.7), or the former GP management plan and team care arrangement items (see AN.15.5).

A patient is eligible for up to 5 services per calendar year.

USE OF THE ITEMS

These items are intended for ongoing care, monitoring and support, as well as routine treatment consistent with the patient’s  GP chronic condition management plan (see AN.0.47), GP management plan, team care arrangement (see AN.15.5), or multidisciplinary care plan (see AN.15.7) between more structured reviews by a GP or prescribed medical practitioner. The services are provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner.

What types of services can be provided?

Any services provided to the patient using these items must be consistent with their GP chronic condition management plan or multidisciplinary care plan. Examples of the types of services that can be provided include but are not limited to:

• Providing immunisations consistent with the plan
  
  
• monitoring a patient’s progress between reviews and recording the results
  
  
• dressing wounds
  
  
• providing advice to the patient on the self-management of their condition

We have a nurse practitioner at the practice. Can they provide the services under items 93201, 93203 or 10997?

Yes. Nurse practitioners are registered nurses with an endorsement as a nurse practitioner. Therefore, provided they are working in general practice or a health service with a relevant section 19(2) exemption to the Health Insurance Act 1973 they meet the definition of a practice nurse for the purposes of this item.

Nurse practitioners may also provide services using the nurse practitioner attendance items (see MN.14.12). If a nurse practitioner provides a service to a patient on behalf of a medical practitioner and an attendance service on the same day the services must be independent services and clinically necessary. Both items cannot be claimed for the same service/time.

A practice nurse is assisting in preparing or reviewing my patient’s plan. Can I use items 93201, 93203 or10997 for their time?

No. The items for preparing and reviewing GP chronic condition management plans (see AN.0.47) and multidisciplinary care plans (see AN.15.7 and AN.15.8) are complete medical services and provide the full MBS benefit for the services. You cannot co-claim a second item for the provision of these services.

Is it ever appropriate to co-claim a planning or review item and items 93201, 93203 or 10997?

Yes. Co-claiming may be appropriate where the service provided by the practice nurse or Aboriginal and Torres Strait Islander health practitioner is separate from, but consistent with, the patient’s plan development or review. The following are examples of scenarios where co-claiming would be appropriate:

Review and wound treatment (e.g., diabetic wounds)

A patient with a chronic medical condition and an existing GP Chronic Condition Management Plan (CCMP) attends a consultation in which the GP and patient review the patient’s CCMP and fully meet the requirements of item 967.

The patient and GP discuss a wound the patient has developed, which is caused by their chronic medical condition. They include treatment of the wound and teaching the patient about wound care in the patient’s CCMP.

The practice nurse is available to dress the wound that day. The practice nurse, for and on behalf of the GP, dresses the wound and provides advice to the patient on caring for the wound. The practice nurse has provided a separate, clinically relevant service, as outlined in the patient’s CCMP.

It is therefore appropriate to claim both the item 967 and 10997 on the same day provided all the requirements of each item have been completed.

Plan/review and need for immunisation identified

A patient, during attendance with their GP, is assessed as having a chronic medical condition. The GP and the patient have agreed to establishing a CCMP and the CCMP is being completed in this appointment.

As part of the CCMP, the GP identifies that the patient’s chronic medical condition puts them at a higher risk of a disease for which there are vaccines available, but that the patient’s vaccinations are not up to date. The GP and patient agree that keeping the patient’s vaccinations up to date should be included in their CCMP.

The practice nurse is available to see the patient that same day. The patient gives consent for the vaccine to be administered and the practice nurse, for and on behalf of the GP, checks that the patient is eligible for the vaccination and administers the vaccine. The practice nurse has provided a separate, clinically relevant service, as outlined in the patient’s CCMP.

It is therefore appropriate to claim both items 965 and 10997 on the same day provided all the requirements of each item have been completed.

Plan/review and administration of parenteral medication (e.g., B12 injection, or denosumab)

A patient with an existing CCMP for their chronic medical condition has booked two appointments on the same day.

The first is for a parenteral medication to help treat their chronic medical condition. It is not appropriate for the patient to self-administer the medication and the need for the treatment is identified in the patient’s CCMP. The patient has also booked their regular review of the CCMP.

The practice nurse, for and on behalf of the GP, administers the medication. The patient has their review of the CCMP with the doctor. The practice nurse has provided a separate, clinically relevant service, as outlined in the patient’s CCMP, in addition to any contribution to the reviews of the CCMP.

It is therefore appropriate to claim items 967 and 10997 on the same day provided the requirements of each item have been completed.

It’s January. Do I need to review my patient’s plan to trigger their eligibility for the 5 services this calendar year?

No, patients’ eligibility is reset on 1 January every year automatically. You are not required to review their plan to enable services or otherwise reset the count, provided patients continue to meet the eligibility requirements for the service.

However, patients with a GP chronic condition management plan must have had their plan prepared or reviewed in the previous 18 months to continue to access services.

My patient only used 3 services last year. Do the unused services rollover to this year?

No, unused services do not rollover. Patients are eligible for up to 5 services per calendar year.

Can my patient access more services by using face to face and telehealth, or seeing a practice nurse and an Aboriginal and Torres Straight Island health practitioner?

No, patients are eligible for up to 5 services per calendar year in total. The 5 services can be made up of any combination of 93201, 93203 and 10997.

My patient is a Torres Strait Islander. Can they access additional services under their GPCCMP using MBS item 10987?

No. The GPCCMP does not provide access to item 10987. Item 10987 is only available for eligible patients who have had a health assessment.

ELIGIBLE PATIENTS

These items are available for patients with at least one chronic condition and who have one of the following plans in place for the management of that condition:

• a GP chronic condition management plan prepared or reviewed in the previous 18 months
  
  
• until 1 July 2027, a GP management plan
  
  
• until 1 July 2027, Team Care Arrangements, or
  
  
• a multidisciplinary care plan

Patients are eligible for up to 5 services (total) under these items each calendar year. The service provided must be consistent with their management plan.

To be eligible for the telephone and telehealth items the patient must have an established clinical relationship with the claiming medical practitioner (see AN.1.1).

ELIGIBLE PRACTITIONERS

These items are medical practitioner items, however, the service is provided on the medical practitioner’s behalf by a practice nurse of an Aboriginal and Torres Strait Islander health practitioner.

This means that the medical practitioner claims the MBS item and retains responsibility for the health, safety and clinical outcomes for the patient.

The terms practice nurse and Aboriginal and Torres Strait Islander health practitioner are defined in the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations).

The Regulations define a practice nurse as “a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or by a health service to which a direction made under subsection 19(2) of the [Health Insurance] Act applies.”

The Regulations define an Aboriginal and Torres Strait Islander health practitioner as ”a person:

a) who is registered under a law of a State or Territory as an Aboriginal and Torres Strait Islander health practitioner; and

b) who is employed by, or whose services are otherwise retained by, a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the [Health Insurance] Act applies.”

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 can be found on the Federal Register of Legislation at www.legislation.gov.au. These items are set out in the following instruments:

• Health Insurance (General Medical Services Table) Regulations 2021 – item 10997

• Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 – items 93201, 93203

Related Items: 10997 93201 93203